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Utah rates for HCPCS L3420

Full sole and heel wedge, between sole

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $34.67 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $37.15 / $37.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $38.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $48.98 / $61.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $58.88 / $100.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $47.86 / $69.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $66.07 / $67.61
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $67.61 / $79.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.55 / $28.84 / $33.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $29.51 / $41.69