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Utah rates for HCPCS L5683

Addition To Lower Extremity Below Knee/Above Knee Custom Fabricated Socket Insert For Other Than Congenital Or Atypical Traumatic Amputee Siliconegel Elastomeric Or Equal For Use With Or Without Locking Mechanism Initial Only(For Other Than I Nitial Use Code L5673 Or L5679)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.00 / $457.00 / $457.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.00 / $502.14 / $4,471.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.52 / $950.52 / $950.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.88 / $950.52 / $1,013.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.07 / $1,174.32 / $1,526.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,408.55 / $1,570.90 / $1,570.90
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.52 / $1,126.02 / $1,689.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.16 / $707.89 / $1,015.55