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Utah rates for HCPCS L5000

Partial foot, shoe insert with longitudinal arch, toe filler

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $363.08 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $489.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $446.68 / $575.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $537.03 / $912.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $436.52 / $645.65
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $602.56 / $616.60
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $616.60 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $363.08 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $302.00 / $457.09