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Utah rates for HCPCS L6620

Upper extremity addition, flexion/extension wrist unit, with or without friction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $204.17 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $302.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $295.12 / $389.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $354.81 / $616.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $288.40 / $426.58
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $407.38 / $416.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $416.87 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $239.88 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $181.97 / $275.42