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Utah rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.90 / $555.90 / $555.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.90 / $745.15 / $6,635.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $1,232.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.89 / $1,232.72 / $1,269.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.21 / $1,260.03 / $1,638.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,511.35 / $1,685.55 / $1,685.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.81 / $1,208.21 / $1,812.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.49 / $861.09 / $1,235.33