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Utah rates for HCPCS L5700

Replacement, socket, below knee (BK), molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,949.84 / $19,054.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $2,818.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $2,511.89 / $3,235.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $2,951.21 / $5,128.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,454.71 / $3,801.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,388.44 / $4,466.84
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,467.37 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,187.76 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,621.81 / $2,454.71