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Utah rates for HCPCS L3050

Foot Arch Support Removable Premolded Metatarsal Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $16.30 / $16.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $30.42 / $159.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.65 / $31.65 / $31.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.10 / $31.65 / $33.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $50.98 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.21 / $56.00 / $56.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.88 / $40.14 / $60.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $25.27 / $29.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.42 / $25.27 / $30.40