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Utah rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $140.55 / $140.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.55 / $146.37 / $1,303.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $366.26 / $390.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.40 / $365.17 / $474.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.00 / $488.49 / $488.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.17 / $350.15 / $525.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.58 / $217.72 / $312.33