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Utah rates for HCPCS L6930

Below elbow, 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
$2,595.84 / $2,595.84 / $2,595.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,595.84 / $2,698.42 / $24,030.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,300.68 / $6,300.68 / $6,300.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,599.50 / $6,300.68 / $6,489.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,630.48 / $7,468.52 / $9,709.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,958.18 / $9,990.71 / $9,990.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,689.06 / $7,161.35 / $10,742.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.54 / $4,020.92 / $5,768.53