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Idaho rates for HCPCS L6624

Upper extremity addition, flexion/extension and rotation wrist unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,698.88 / $3,730.22 / $3,730.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.26 / $2,941.06 / $2,941.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,146.96 / $2,146.96 / $4,826.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,308.09 / $3,180.20 / $4,437.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,993.77 / $4,215.64 / $4,437.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $3,274.89 / $3,900.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,885.65 / $4,333.52 / $6,500.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,106.26 / $3,217.45 / $4,659.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,873.42 / $2,026.24 / $3,208.21