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Utah rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.03 / $938.03 / $938.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.03 / $1,151.41 / $10,253.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $1,819.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,819.89 / $1,940.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,426.12 / $2,291.75 / $2,979.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,748.86 / $3,065.70 / $3,065.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,745.72 / $2,197.50 / $3,296.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.27 / $1,776.27 / $1,776.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,311.94 / $1,453.01 / $2,421.67