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Utah rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.50 / $239.50 / $239.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.50 / $240.93 / $2,145.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $960.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.77 / $723.83 / $940.97
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.20 / $968.27 / $968.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.36 / $694.06 / $1,041.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.97 / $370.99 / $532.23