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Utah rates for HCPCS L5656

Addition to lower extremity, socket insert, knee disarticulation (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.40 / $143.40 / $143.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.40 / $192.33 / $1,712.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.84 / $335.84 / $335.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $607.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.94 / $335.40 / $436.02
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.30 / $448.67 / $448.67
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.49 / $321.61 / $482.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.56 / $222.12 / $317.86