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Utah rates for HCPCS L3250

Orthopedic Footwear Custom Molded Shoe Removable Inner Mold Prosthetic Shoe Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.15 / $114.15 / $114.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.15 / $114.15 / $187.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.68 / $210.68 / $210.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.80 / $210.68 / $217.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $161.07 / $279.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.97 / $313.68 / $401.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.90 / $142.69 / $173.67