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Utah rates for HCPCS L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,350.18 / $8,350.18 / $8,350.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,350.18 / $9,164.08 / $81,610.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $16,200.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $16,200.25 / $18,997.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,251.37 / $21,373.18 / $27,785.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,636.25 / $28,591.13 / $28,591.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,280.78 / $20,494.12 / $30,741.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,678.56 / $12,934.33 / $18,555.95