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Utah rates for HCPCS L6624

Upper extremity addition, flexion/extension and rotation wrist unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,344.23 / $19,498.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $3,162.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $3,388.44 / $4,265.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,388.44 / $3,981.07 / $6,918.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,311.31 / $4,786.30
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,570.88 / $4,677.35
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $4,677.35 / $5,370.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,691.53 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,041.74 / $3,019.95