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Utah rates for HCPCS L6630

Upper extremity addition, stainless steel, any wrist

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $151.36 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $173.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $190.55 / $245.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $229.09 / $389.05
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $186.21 / $275.42
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $257.04 / $263.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $263.03 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $128.82 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $128.82 / $194.98