go back

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
$1,262.19 / $1,262.19 / $1,262.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,262.19 / $1,387.23 / $12,354.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $2,448.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $2,448.80 / $2,871.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,007.36 / $3,237.68 / $4,208.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,883.46 / $4,331.07 / $4,331.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,466.26 / $3,104.51 / $4,656.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.30 / $1,955.12 / $2,804.87