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Utah rates for HCPCS L3100

Hallux-valgus night dynamic splint, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $14.13 / $14.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $28.84 / $56.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $34.67 / $34.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $37.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $42.66 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $45.71 / $79.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $38.02 / $54.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $52.48 / $53.70
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $53.70 / $61.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $22.91 / $26.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $23.44 / $33.11