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Utah rates for HCPCS L5964

Addition Endoskeletal System Above Knee Flexible Protective Outer Surface Covering System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.03 / $438.72 / $3,907.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.38 / $702.38 / $702.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.74 / $702.38 / $748.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.87 / $927.21 / $1,205.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,112.15 / $1,240.33 / $1,240.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.30 / $889.08 / $1,333.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.33 / $560.78 / $804.51