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Utah rates for HCPCS L3540

Orthopedic shoe addition, sole, full

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $16.98 / $16.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $32.36 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $26.92 / $38.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.62 / $45.71 / $58.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $53.70 / $93.33
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $44.67 / $64.57
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $61.66 / $63.10
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $63.10 / $72.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.91 / $26.92 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $27.54 / $38.90