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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
$18.60 / $18.60 / $18.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.60 / $24.96 / $222.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.36 / $37.36 / $37.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.27 / $37.36 / $39.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $43.01 / $56.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.58 / $57.53 / $57.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.75 / $41.24 / $61.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.02 / $28.82 / $41.34