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Utah rates for HCPCS L5645

Addition to lower extremity, below knee (BK), flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $549.54 / $4,677.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $933.25 / $1,202.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,122.02 / $1,949.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,071.52
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $1,288.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,288.25 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $537.03 / $724.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $478.63 / $724.44