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Utah rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,454.71 / $23,442.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $3,019.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $3,311.31 / $4,265.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,981.07 / $6,918.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,235.94 / $4,897.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $4,570.88 / $5,370.32
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $4,677.35 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,691.53 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,041.74 / $3,019.95