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Utah rates for HCPCS L5920

Addition Endoskeletal System Above Knee Or Hip Disarticulation Alignable System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.11 / $205.11 / $205.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.11 / $206.33 / $1,837.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $397.94 / $397.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $397.94 / $486.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.67 / $615.61 / $800.29
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$738.40 / $823.51 / $823.51
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.94 / $590.29 / $885.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.87 / $317.70 / $455.79