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Utah rates for HCPCS L5990

Addition To Lower Extremity Prosthesis User Adjustable Heel Height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.14 / $630.14 / $630.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.14 / $692.57 / $6,167.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,222.54 / $1,222.54 / $1,222.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.45 / $892.45 / $2,564.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.14 / $1,616.37 / $2,101.28
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,938.78 / $2,162.23 / $2,162.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,231.27 / $1,549.89 / $2,324.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.31 / $976.08 / $1,400.31