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Utah rates for HCPCS L3003

Foot insert, removable, molded to patient model, silicone gel, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $112.20 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $154.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $60.26 / $190.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $186.21 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $151.36 / $218.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $213.80 / $218.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $218.78 / $251.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $93.33 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $93.33 / $134.90