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Utah rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.25 / $215.25 / $215.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.25 / $253.92 / $2,261.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $581.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.99 / $553.21 / $719.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.55 / $740.03 / $740.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.40 / $530.45 / $795.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.05 / $333.42 / $478.34