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Utah rates for HCPCS L5646

Addition To Lower Extremity Below Knee Air Flu Id Gel Or Equal Cushion Socket. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.80 / $211.80 / $211.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.80 / $213.06 / $1,897.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.92 / $410.92 / $410.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.97 / $410.92 / $491.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.53 / $621.83 / $808.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$745.86 / $831.83 / $831.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.67 / $596.25 / $894.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.23 / $328.08 / $470.67