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Utah rates for HCPCS L5000

Partial Foot Shoe Insert With Longitudinal Arch Toe Filler (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.32 / $195.32 / $195.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.32 / $354.01 / $2,081.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.90 / $459.90 / $459.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.73 / $335.73 / $810.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.48 / $442.71 / $575.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.01 / $592.22 / $592.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.23 / $424.50 / $636.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.17 / $302.54 / $434.04