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Utah rates for HCPCS L6647

Upper Extremity Addition Shoulder Lock Mechanism Body Powered Actuator

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.36 / $180.36 / $180.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.36 / $198.21 / $1,765.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.51 / $405.51 / $405.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.02 / $405.51 / $432.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.84 / $462.66 / $601.45
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$554.95 / $618.91 / $618.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.44 / $443.63 / $665.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.24 / $279.36 / $390.25