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Utah rates for HCPCS L6026

Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,966.15 / $1,966.15 / $1,966.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,966.15 / $1,966.15 / $16,049.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,323.97 / $3,323.97 / $3,323.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,426.50 / $3,323.97 / $3,423.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,587.53 / $4,173.45 / $5,425.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,005.88 / $5,582.87 / $5,582.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,179.08 / $4,001.80 / $6,002.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,136.31 / $2,244.96 / $3,574.81