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Utah rates for HCPCS L6703

Terminal device, passive hand/mitt, any material, any size

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $218.78 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $288.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $323.59 / $416.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $389.05 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $316.23 / $426.58
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $446.68 / $457.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $457.09 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $257.04 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $194.98 / $295.12