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Utah rates for HCPCS L3660

Shoulder orthosis (SO), figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $57.54 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $79.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $60.26 / $131.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $128.82 / $223.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $104.71 / $125.89
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $147.91 / $151.36
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $151.36 / $151.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $56.23 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $56.23 / $81.28