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Utah rates for HCPCS L6632

Upper extremity addition, latex suspension sleeve, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $25.12 / $25.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $45.71 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $35.48 / $60.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $75.86 / $97.72
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $91.20 / $158.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $74.13 / $87.10
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $104.71 / $107.15
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $107.15 / $107.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $39.81 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $38.90 / $58.88