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Utah rates for HCPCS L5647

Addition to lower extremity, below knee (BK), suction socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.50 / $307.50 / $307.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.50 / $412.43 / $3,672.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $596.58 / $596.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $1,118.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.62 / $851.01 / $1,106.31
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.75 / $1,138.41 / $1,138.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.24 / $816.01 / $1,224.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.93 / $635.08 / $717.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.07 / $476.31 / $683.33