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Utah rates for HCPCS L6055

Wrist disarticulation, molded socket with expandable interface, flexible elbow hinges, triceps pad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.47 / $1,023.47 / $1,023.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.47 / $1,259.10 / $11,213.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,476.09 / $2,476.09 / $2,476.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.55 / $2,476.09 / $2,550.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,537.51 / $2,479.87 / $3,223.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,974.50 / $3,317.35 / $3,317.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,889.01 / $2,377.88 / $3,566.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.42 / $1,585.34 / $2,274.37