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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
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $1,023.29 / $10,000.00
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 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,258.93 / $1,621.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,513.56 / $2,630.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,230.27 / $1,862.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,737.80 / $1,778.28
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,148.15 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $870.96 / $1,288.25