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Utah rates for HCPCS L6715

Terminal Device Multiple Articulating Digit Includes Motor(S) Initial Issue Or Replacement (Reinstated Code Previous Description Was Terminal Device Hook Dorrance Or Equal Model # 5xa (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,859.38 / $1,859.38 / $1,859.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,677.56 / $1,859.38 / $10,733.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,381.07 / $2,381.07 / $2,381.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,738.18 / $2,381.07 / $2,452.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $60.00 / $3,432.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,380.69 / $3,770.36 / $3,770.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,146.98 / $2,702.60 / $4,053.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.89 / $1,699.03 / $2,618.15