go back

Utah rates for HCPCS L5640

Addition to lower extremity, knee disarticulation, leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.19 / $247.19 / $247.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.19 / $301.70 / $2,686.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$572.20 / $572.20 / $572.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.71 / $572.20 / $590.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.15 / $747.03 / $971.13
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$896.04 / $999.32 / $999.32
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.04 / $716.31 / $1,074.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.71 / $382.88 / $549.29