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Utah rates for HCPCS L5590

Preparatory, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$929.28 / $929.28 / $929.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.28 / $1,246.39 / $11,099.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,289.62 / $2,289.62 / $2,289.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,671.42 / $1,671.42 / $4,144.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,667.83 / $2,690.06 / $3,497.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,226.62 / $3,598.53 / $3,598.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,049.12 / $2,579.42 / $3,869.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,299.70 / $1,439.45 / $2,010.78