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Utah rates for HCPCS L5631

Addition To Lower Extremity Above Knee Or Knee Disarticulation Acrylic Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.85 / $169.85 / $169.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.85 / $170.85 / $1,521.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $329.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $329.53 / $351.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.69 / $384.99 / $500.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.77 / $515.00 / $515.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.26 / $369.15 / $553.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.55 / $263.08 / $377.44