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Utah rates for HCPCS L5654

Addition To Lower Extremity Socket Insert Symes (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $128.19 / $128.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.19 / $158.44 / $1,411.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $306.16 / $326.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.13 / $292.14 / $379.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.42 / $390.81 / $390.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.54 / $280.13 / $420.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.49 / $198.59 / $284.89