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Utah rates for HCPCS L6500

Above Elbow Molded Socket Endoskeletal System Including Soft Prosthetic Tissue Shaping

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,192.80 / $1,192.80 / $1,192.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,192.80 / $1,333.18 / $11,872.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,970.85 / $2,970.85 / $2,970.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,168.71 / $2,970.85 / $3,167.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,196.05 / $3,542.02 / $4,604.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,248.51 / $4,738.20 / $4,738.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,698.11 / $3,396.34 / $5,094.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,668.24 / $1,847.62 / $2,580.96