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Utah rates for HCPCS L5930

Addition Endoskeletal System High Activity Knee Control Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.59 / $1,176.59 / $1,176.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,176.59 / $1,284.92 / $11,442.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,282.71 / $2,282.71 / $2,282.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,666.39 / $1,666.39 / $4,757.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,853.50 / $2,989.53 / $3,886.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,585.82 / $3,999.13 / $3,999.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,277.25 / $2,866.58 / $4,299.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,982.23 / $1,982.23 / $1,982.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,685.08 / $1,822.54 / $2,974.49