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Utah rates for HCPCS L5973

Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $7,762.47 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,762.47 / $10,964.78 / $89,125.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $12,882.50 / $12,882.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,332.54 / $9,332.54 / $13,489.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $15,488.17 / $19,952.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,848.93 / $18,620.87 / $32,359.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,748.98 / $15,135.61 / $22,387.21
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,054.61 / $21,379.62 / $21,877.62
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,488.17 / $21,877.62 / $25,118.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $12,302.69 / $14,125.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $9,332.54 / $14,125.38