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Utah rates for HCPCS L5961

Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,120.90 / $2,120.90 / $2,120.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,120.90 / $2,120.90 / $17,765.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,728.42 / $3,728.42 / $3,728.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,721.75 / $3,728.42 / $3,840.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,785.47 / $4,492.70 / $5,840.51
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,388.80 / $6,009.93 / $6,009.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,422.27 / $4,307.92 / $6,461.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,313.71 / $2,562.50 / $3,856.19