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Utah rates for HCPCS L6629

Upper Extremity Addition Quick Disconnect Lamination Collar With Coupling Piece Otto Bock Or Equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.56 / $56.56 / $56.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.56 / $68.09 / $606.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.00 / $113.00 / $113.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.49 / $113.00 / $126.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.57 / $160.61 / $208.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.64 / $214.84 / $214.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.33 / $154.00 / $231.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.09 / $87.61 / $125.68