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Utah rates for HCPCS L5200

Above Knee Molded Socket Single Axis Constant Friction Knee Shin Sach Foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.01 / $1,277.01 / $1,277.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,277.01 / $1,560.56 / $13,897.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $2,728.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $5,138.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,801.21 / $2,894.53 / $3,762.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,471.87 / $3,872.04 / $3,872.04
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,204.87 / $2,775.48 / $4,163.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.03 / $1,978.08 / $2,837.81