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Utah rates for HCPCS L3670

Shoulder Orthosis Acromio/Clavicular (Canvas And Webbing Type) Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.60 / $40.15 / $111.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.15 / $57.80 / $355.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $86.64 / $91.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.25 / $86.64 / $92.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.63 / $91.00 / $118.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.16 / $121.74 / $121.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.31 / $87.26 / $130.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.78 / $61.64 / $73.04