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Utah rates for HCPCS L6360

Interscapular thoracic, passive restoration (complete prosthesis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,238.72 / $22,387.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,388.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,818.38 / $3,630.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $5,754.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,754.23 / $4,466.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,801.89 / $5,248.07
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,890.45 / $5,754.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $2,570.40 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,905.46 / $2,884.03