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Utah rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.47 / $107.47 / $107.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.47 / $113.73 / $1,012.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.59 / $209.59 / $209.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $209.59 / $223.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.02 / $243.59 / $316.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.19 / $325.86 / $325.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.56 / $233.58 / $350.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.72 / $221.96 / $250.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.31 / $166.47 / $238.83