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Utah rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,066.25 / $1,066.25 / $1,066.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.25 / $1,430.10 / $12,735.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,482.86 / $2,482.86 / $2,482.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,482.86 / $2,646.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,643.25 / $2,640.68 / $3,432.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,167.39 / $3,532.47 / $3,532.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,011.51 / $2,532.08 / $3,798.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,376.34 / $2,202.14 / $2,488.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.19 / $1,651.61 / $2,369.44