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Utah rates for HCPCS L3000

Foot Insert Removable Molded To Patient Model Ucb Type Berkeley Shell Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.90 / $108.90 / $108.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.90 / $406.12 / $1,014.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.27 / $211.27 / $211.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.22 / $211.27 / $225.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $60.00 / $340.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.01 / $373.63 / $373.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.75 / $267.82 / $401.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.07 / $168.68 / $215.98