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Utah rates for HCPCS L6638

Upper Extremity Addition To Prosthesis Electric Locking Feature Only For Use With Manually Powered Elbow

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.59 / $868.59 / $868.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.59 / $954.64 / $8,501.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $1,952.91 / $1,952.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,952.91 / $2,081.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,381.39 / $2,228.06 / $2,896.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,672.47 / $2,980.50 / $2,980.50
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,697.20 / $2,136.42 / $3,204.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.82 / $1,345.45 / $1,930.21