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Utah rates for HCPCS L3040

Foot, arch support, removable, premolded, longitudinal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $33.11 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $33.11 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $23.99 / $35.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $46.77 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $50.12 / $87.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $40.74 / $58.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $57.54 / $58.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $58.88 / $67.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.89 / $25.12 / $29.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $25.12 / $36.31