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Utah rates for HCPCS L6692

Upper Extremity Addition Silicone Gel Insert Or Equal Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.18 / $216.18 / $216.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.18 / $289.95 / $2,582.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.41 / $419.41 / $419.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.17 / $306.17 / $904.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.10 / $613.08 / $797.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.36 / $820.12 / $820.12
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.01 / $587.86 / $881.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.35 / $334.86 / $479.20