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Utah rates for HCPCS L5987

All Lower Extremity Prosthesis Shank Foot System With Vertical Loading Pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,498.65 / $2,498.65 / $2,498.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,498.65 / $2,746.17 / $24,455.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,042.00 / $6,042.00 / $6,042.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $6,042.00 / $7,085.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $60.00 / $7,804.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,687.73 / $8,573.83 / $8,573.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,882.24 / $6,145.72 / $9,218.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,494.61 / $3,870.38 / $5,552.55