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Utah rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.72 / $188.72 / $188.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.72 / $253.11 / $2,254.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.03 / $379.03 / $379.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $685.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.60 / $570.33 / $741.42
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$684.09 / $762.94 / $762.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.45 / $546.88 / $820.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.93 / $292.32 / $419.37