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Utah rates for HCPCS L5629

Addition To Lower Extremity Below Knee Acrylic Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $122.85 / $122.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.85 / $123.58 / $1,100.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.05 / $248.05 / $248.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $248.05 / $264.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.63 / $278.45 / $361.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.99 / $372.49 / $372.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.11 / $267.00 / $400.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.82 / $190.30 / $273.00