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Utah rates for HCPCS L5638

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.13 / $188.13 / $188.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.13 / $252.33 / $2,247.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.81 / $503.81 / $503.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.78 / $367.78 / $912.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.50 / $568.54 / $739.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$681.96 / $760.56 / $760.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.09 / $545.16 / $817.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.77 / $388.77 / $388.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.43 / $291.41 / $417.02