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Utah rates for HCPCS L5682

Addition to lower extremity, below knee (BK), thigh lacer, gluteal/ischial, molded

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $436.52 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $512.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $549.54 / $707.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $660.69 / $1,148.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $537.03 / $812.83
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $758.58 / $776.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $758.58 / $933.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $489.78 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $371.54 / $562.34