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Utah rates for HCPCS L5652

Addition To Lower Extremity Suction Suspension Above Knee Or Knee Disarticulation Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.53 / $168.53 / $168.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.53 / $169.53 / $1,509.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.50 / $338.50 / $338.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.11 / $338.50 / $402.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.79 / $509.35 / $662.15
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.94 / $681.36 / $681.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.99 / $488.40 / $732.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.71 / $261.06 / $374.52