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Utah rates for HCPCS L4210

Repair Of Orthotic Device Repair Or Replace Minor Parts (Special Coverage Instructions Apply. See Mcm: 2133 2100.4 2130d)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $20.00 / $20.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $25.19 / $364.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.65 / $117.89 / $117.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.88 / $17.13 / $60.00