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Utah rates for HCPCS L5940

Addition, endoskeletal system, below knee (BK), ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $363.08 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $380.19 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $467.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $588.84 / $758.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $707.95 / $1,230.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $575.44 / $794.33
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $794.33 / $812.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $812.83 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $316.23 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $302.00 / $446.68