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Utah rates for HCPCS L3960

Shoulder Elbow Wrist Hand Orthosis Abduction Positioning Airplane Design Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.95 / $260.95 / $260.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.95 / $486.62 / $3,116.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $516.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $510.00 / $543.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.71 / $591.47 / $768.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.44 / $791.22 / $791.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.55 / $567.14 / $850.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.49 / $395.77 / $474.73