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Utah rates for HCPCS L4130

Replace Pretibial Shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.02 / $180.02 / $180.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.02 / $254.50 / $2,150.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.57 / $373.57 / $373.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.70 / $373.57 / $384.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.74 / $468.94 / $609.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.47 / $627.29 / $627.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.21 / $449.65 / $674.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.38 / $278.85 / $364.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.34 / $278.85 / $278.85