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Alaska rates for HCPCS L6624

Upper extremity addition, flexion/extension and rotation wrist unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,885.80 / $3,885.80 / $3,885.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,941.06 / $2,941.06 / $2,941.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,146.96 / $2,146.96 / $2,146.96
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.09 / $1,308.09 / $1,308.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,215.64 / $4,215.64 / $6,656.28
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,885.65 / $3,885.65 / $4,333.52
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,511.12 / $4,333.52 / $8,936.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.09 / $1,308.09 / $2,941.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,108.52 / $3,689.72 / $8,936.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,213.83 / $2,213.83 / $9,801.54