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Utah rates for HCPCS L5312

Knee disarticulation (or through knee), molded socket, single axis knee, pylon, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,454.71 / $20,417.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $3,235.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $3,162.28 / $4,073.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,801.89 / $6,606.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,090.30 / $4,677.35
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $4,365.16 / $5,248.07
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $4,466.84 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $2,630.27 / $2,951.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,995.26 / $3,019.95