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Utah rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.28 / $192.28 / $192.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.28 / $257.89 / $2,296.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.63 / $380.63 / $380.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.86 / $380.63 / $458.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.29 / $581.12 / $755.45
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$697.03 / $777.37 / $777.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.65 / $557.22 / $835.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.93 / $297.85 / $427.29