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Utah rates for HCPCS L5925

Addition, endoskeletal system, above knee (AK), knee disarticulation or hip disarticulation, manual lock

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.88 / $129.88 / $129.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.88 / $169.60 / $1,510.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.88 / $260.88 / $260.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.44 / $260.88 / $310.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.38 / $392.55 / $510.31
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.85 / $525.12 / $525.12
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.02 / $376.40 / $564.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.66 / $201.20 / $288.64