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Utah rates for HCPCS L3252

Foot Shoe Molded To Patient Model Plastazote (Or Similar) Custom Fabricated Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.51 / $62.51 / $62.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.72 / $62.51 / $102.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.50 / $56.50 / $56.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.25 / $56.50 / $58.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $45.00 / $80.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.02 / $171.84 / $220.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.40 / $131.40 / $131.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.83 / $78.17 / $95.08