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Utah rates for HCPCS L5972

All Lower Extremity Prostheses Foot Flexible Keel (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.24 / $136.24 / $136.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.24 / $182.73 / $1,627.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.77 / $293.77 / $293.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.45 / $293.77 / $313.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.16 / $385.75 / $501.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.69 / $516.02 / $516.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.83 / $369.88 / $554.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.54 / $211.03 / $302.75