go back

Utah rates for HCPCS L5646

Addition to lower extremity, below knee (BK), air, fluid, gel or equal, cushion socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $398.11 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $489.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $616.60 / $812.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $741.31 / $1,288.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $602.56 / $758.58
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $870.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $870.96 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $331.13 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $331.13 / $489.78