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Utah rates for HCPCS L5651

Addition to lower extremity, above knee (AK), flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$464.23 / $464.23 / $464.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.23 / $466.99 / $4,158.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.11 / $1,200.11 / $1,200.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.09 / $1,200.11 / $1,407.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$869.86 / $1,403.00 / $1,823.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,682.84 / $1,876.81 / $1,876.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.73 / $1,345.30 / $2,017.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.25 / $719.09 / $1,031.63