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Utah rates for HCPCS L5684

Addition to lower extremity, below knee, fork strap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $33.88 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.54 / $27.54 / $39.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $42.66 / $56.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $51.29 / $89.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $41.69 / $66.07
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $58.88 / $79.43
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $60.26 / $89.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $38.02 / $61.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $28.84 / $43.65