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Utah rates for HCPCS L3050

Foot, arch support, removable, premolded, metatarsal, 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 / $30.20 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.62 / $31.62 / $31.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $22.91 / $33.88
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