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Utah rates for HCPCS L3956

Addition of joint to upper extremity orthosis, any material; per joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.00 / $48.00 / $48.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $48.00 / $48.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $141.55 / $152.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $45.00 / $60.00