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Utah rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $8.91 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $20.89 / $28.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $17.38 / $25.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $19.95 / $19.95
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $34.67
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $16.22 / $18.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.24 / $8.71 / $35.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $8.71 / $13.18