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Utah rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,630.27 / $21,379.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,548.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $3,715.35 / $4,897.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $4,466.84 / $7,762.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,715.35 / $5,370.32
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $5,128.61 / $5,248.07
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $5,248.07 / $6,025.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,019.95 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,290.87 / $3,388.44