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Utah rates for HCPCS L4100

Replace Leather Cuff Kafo, Proximal Thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.85 / $37.85 / $37.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.85 / $53.50 / $452.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.43 / $73.43 / $73.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.60 / $73.42 / $78.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.38 / $85.79 / $111.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.90 / $114.76 / $114.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.34 / $82.26 / $123.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.90 / $58.63 / $75.06