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Utah rates for HCPCS L5670

Addition to lower extremity, below knee (BK), molded supracondylar suspension (PTS or similar)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.90 / $104.90 / $104.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.90 / $140.69 / $1,252.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.51 / $203.51 / $203.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.56 / $203.51 / $250.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.54 / $317.01 / $412.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.25 / $424.07 / $424.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.48 / $303.98 / $455.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.71 / $162.47 / $233.10