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Utah rates for HCPCS A5113

Leg Strap; Latex Replacement Only Per Set (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $3.51 / $16.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.96 / $3.96 / $3.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.37 / $3.96 / $7.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.34 / $4.09 / $5.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $5.47 / $5.47
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.12 / $3.91 / $5.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.80 / $4.66