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Utah rates for HCPCS L4387

Walking Boot Non-Pneumatic With Or Without Joints With Or Without Interface Material Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.16 / $72.05 / $78.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $109.38 / $425.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.47 / $120.81 / $120.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.19 / $120.81 / $128.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $140.97 / $183.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.10 / $188.59 / $188.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.39 / $135.18 / $202.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.66 / $85.13 / $102.38