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Utah rates for HCPCS L5986

All lower extremity prostheses, multiaxial rotation unit (MCP or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $457.09 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $707.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $741.31 / $954.99
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $891.25 / $1,548.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $977.24
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,023.29 / $1,023.29
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,023.29 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $501.19 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $380.19 / $575.44