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Utah rates for HCPCS L6694

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $258.31 / $258.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.31 / $304.70 / $2,713.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $528.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $563.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.60 / $663.88 / $863.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$796.30 / $888.09 / $888.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.71 / $636.58 / $954.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.27 / $400.12 / $574.02