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Idaho rates for HCPCS L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,792.08 / $2,476.91 / $2,476.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,848.12 / $1,952.91 / $1,952.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,952.91 / $2,081.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.59 / $2,075.57 / $2,946.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,651.90 / $2,799.23 / $2,946.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,580.11 / $2,877.50 / $4,316.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,062.59 / $2,136.42 / $3,093.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.97 / $1,345.45 / $2,133.87