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Utah rates for HCPCS L5668

Addition To Lower Extremity Below Knee Molded Distal Cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.04 / $39.04 / $39.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.04 / $52.36 / $466.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.19 / $89.19 / $89.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $89.19 / $95.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.06 / $88.49 / $115.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.13 / $118.36 / $118.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.40 / $84.85 / $127.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.59 / $60.47 / $86.75