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Utah rates for HCPCS L5686

Addition to lower extremity, below knee (BK), back check (extension control)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.05 / $19.05 / $19.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.05 / $36.31 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $44.67 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $47.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $52.48 / $69.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $63.10 / $109.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $51.29 / $77.62
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $72.44 / $75.86
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $74.13 / $93.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $37.15 / $45.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $30.90 / $45.71