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Utah rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,071.52 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,862.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,513.56 / $1,905.46
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,819.70 / $3,090.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $2,137.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,041.74 / $2,089.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,089.30 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,202.26 / $1,380.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $912.01 / $1,348.96