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Utah rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.68 / $111.68 / $111.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.68 / $149.19 / $1,328.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.98 / $232.98 / $232.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $232.98 / $273.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.94 / $253.13 / $329.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.61 / $338.61 / $338.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.82 / $242.72 / $364.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.19 / $172.98 / $241.64