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Utah rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $371.54 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $478.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $446.68 / $588.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $537.03 / $933.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $436.52 / $660.69
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $616.60 / $630.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $630.96 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $407.38 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $309.03 / $457.09