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Utah rates for HCPCS L3003

Foot Insert Removable Molded To Patient Model Silicone Gel Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.40 / $60.40 / $60.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.40 / $69.98 / $591.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.11 / $149.11 / $149.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.85 / $149.11 / $153.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $60.00 / $188.68
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.84 / $207.26 / $207.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.02 / $148.56 / $222.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.89 / $93.57 / $119.80