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Utah 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
Facility
Modifier
Low / Median / High Price
$794.47 / $794.47 / $794.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.47 / $873.16 / $7,775.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $1,786.24 / $1,786.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.96 / $1,786.24 / $1,839.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,263.49 / $2,037.90 / $2,649.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,444.38 / $2,726.12 / $2,726.12
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,552.36 / $1,954.09 / $2,931.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.14 / $1,230.61 / $1,765.48