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Utah rates for HCPCS L5639

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $812.83 / $7,762.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,318.26 / $1,698.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,584.89 / $2,691.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $1,621.81
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $1,819.70
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,819.70 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $891.25 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $676.08 / $1,000.00