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Utah rates for HCPCS L5688

Addition to lower extremity, below knee (BK), waist belt, webbing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $22.91 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $42.66 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $33.11 / $48.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $53.70 / $69.18
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $64.57 / $112.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $52.48 / $77.62
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $74.13 / $85.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $74.13 / $102.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $48.98 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $36.31 / $54.95