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Utah rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.58 / $195.58 / $195.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.58 / $213.59 / $1,902.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $436.96 / $436.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $436.96 / $450.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.12 / $496.97 / $646.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.09 / $664.80 / $664.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.55 / $476.53 / $714.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.54 / $302.95 / $434.63