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Utah rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $2,290.87 / $18,620.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $3,235.94 / $4,168.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,890.45 / $6,760.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,162.28 / $4,570.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,466.84 / $4,570.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $4,570.88 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,570.40 / $2,951.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,949.84 / $2,951.21