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Utah rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $72.44 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $89.13 / $114.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $107.15 / $181.97
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $87.10 / $128.82
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $120.23 / $138.04
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $123.03 / $165.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $79.43 / $91.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $60.26 / $91.20