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Utah rates for HCPCS L6920

Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,579.84 / $2,579.84 / $2,579.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,579.84 / $2,899.21 / $25,818.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,541.83 / $6,541.83 / $6,541.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,775.54 / $6,541.83 / $6,738.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,407.04 / $7,108.14 / $9,240.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,525.92 / $9,508.64 / $9,508.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,414.55 / $6,815.80 / $10,223.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,608.17 / $3,996.14 / $5,732.98