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Utah rates for HCPCS L3265

Plastazote Sandal, Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.95 / $6.95 / $6.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.58 / $6.95 / $12.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.65 / $28.65 / $28.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.91 / $28.65 / $28.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.88 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.18 / $19.05 / $24.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.34 / $8.66 / $10.60