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Utah rates for HCPCS L5105

Below knee (BK), plastic socket, joints and thigh lacer, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.91 / $1,342.91 / $1,342.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,342.91 / $1,801.18 / $16,040.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,006.81 / $3,006.81 / $3,006.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,194.96 / $3,006.81 / $3,097.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,070.27 / $3,339.16 / $4,340.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,005.20 / $4,466.84 / $4,466.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,543.58 / $3,201.83 / $4,802.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,878.20 / $2,080.16 / $2,984.25