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Idaho rates for HCPCS L6621

Upper Extremity Prosthesis Addition Flexion/Extension Wrist With Or Without Friction For Use With External Powered Terminal Device

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,639.13 / $2,265.50 / $2,265.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,690.39 / $1,786.24 / $1,786.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.96 / $1,303.96 / $1,839.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.47 / $1,898.42 / $2,695.08
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,425.57 / $2,560.33 / $2,695.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,988.96 / $2,368.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,359.90 / $2,631.91 / $3,947.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,886.56 / $1,954.09 / $2,829.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,137.80 / $1,230.61 / $2,088.48