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Utah rates for HCPCS L3257

Orthopedic Footwear Additional Charge For Split Size (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.40 / $11.40 / $11.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.77 / $11.40 / $18.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.09 / $28.09 / $28.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.51 / $28.09 / $29.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.92 / $30.95 / $39.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.66 / $23.66 / $23.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.94 / $14.08 / $17.23