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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
$630.96 / $630.96 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,148.15 / $9,332.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,621.81 / $2,089.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,949.84 / $3,388.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,584.89 / $2,290.87
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,238.72 / $2,238.72
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,238.72 / $2,630.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,288.25 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $977.24 / $1,479.11