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Utah rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,258.93 / $12,022.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,737.80 / $2,187.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,089.30 / $3,548.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,698.24 / $2,238.72
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,344.23 / $2,398.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,398.83 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,380.38 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,047.13 / $1,548.82