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Utah rates for HCPCS L5685

Addition To Lower Extremity Prosthesis Below Kneesuspension/Sealing Sleeve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.49 / $44.49 / $44.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.49 / $48.90 / $435.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $100.03 / $106.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.75 / $114.12 / $148.35
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.88 / $152.66 / $152.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.93 / $109.43 / $164.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.22 / $68.92 / $98.86