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Utah rates for HCPCS L5692

Addition to lower extremity, above knee (AK), pelvic control belt, light

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $95.50 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $107.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $120.23 / $154.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $144.54 / $251.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $117.49 / $177.83
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $165.96 / $190.55
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $169.82 / $229.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $104.71 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $79.43 / $120.23