go back

Utah rates for HCPCS L5988

Addition To Lower Limb Prosthesis Vertical Shock Reducing Pylon Feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.87 / $693.87 / $693.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.87 / $762.61 / $6,791.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.19 / $1,346.19 / $1,346.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.72 / $1,346.19 / $1,435.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.48 / $1,779.82 / $2,313.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,134.82 / $2,380.88 / $2,380.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.77 / $1,706.61 / $2,559.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.45 / $1,074.80 / $1,541.94