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Utah rates for HCPCS L5622

Addition To Lower Extremity Test Socket Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.13 / $140.13 / $140.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.13 / $147.41 / $1,312.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $274.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $200.41 / $564.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.94 / $317.64 / $412.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.01 / $424.92 / $424.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.96 / $304.58 / $456.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.00 / $217.07 / $311.42