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Utah rates for HCPCS L5673

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated From Existing Mold Or Prefabricated Socket Insert Silicone Gel Elastomeric Or Equal For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $258.31 / $258.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.31 / $304.70 / $2,713.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.15 / $501.15 / $501.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.84 / $501.15 / $587.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.60 / $663.88 / $863.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$796.30 / $888.09 / $888.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.71 / $636.58 / $954.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.27 / $400.12 / $574.02