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Utah rates for HCPCS L8415

Prosthetic sheath, upper limb, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $14.13 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.22 / $16.22 / $16.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $17.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $20.89 / $30.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $25.12 / $42.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $20.42 / $30.20
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $28.18 / $32.36
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $28.84 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.72 / $14.45 / $19.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.88 / $19.05