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Utah rates for HCPCS L6684

Upper extremity addition, test socket, shoulder disarticulation or interscapular thoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $134.90 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $239.88 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $389.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $331.13 / $436.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $691.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $323.59 / $489.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $457.09 / $562.34
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $467.74 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $275.42 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $208.93 / $316.23