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Utah rates for HCPCS L5505

Initial Above Knee - Knee Disarticulation Ischial Level Socket Non-Alignable System Pylon No Cover Sach Foot Plaster Socket Direct Formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.36 / $672.36 / $672.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.36 / $901.80 / $8,030.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,620.00 / $1,620.00 / $1,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $1,668.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.87 / $1,725.60 / $2,243.28
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,069.79 / $2,308.36 / $2,308.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.46 / $1,654.63 / $2,481.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$940.37 / $1,041.48 / $1,494.14