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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
$2,570.40 / $2,570.40 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $4,786.30 / $38,904.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $6,760.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $7,079.46 / $9,120.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $8,511.38 / $14,791.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,918.31 / $10,000.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,709.64 / $9,772.37 / $10,000.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,079.46 / $10,000.00 / $11,481.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,466.84 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,981.07 / $6,025.60