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Utah rates for HCPCS L6641

Upper Extremity Addition Excursion Amplifier Pulley Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.01 / $62.01 / $62.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.01 / $78.12 / $695.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.98 / $126.98 / $126.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.70 / $92.70 / $277.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.69 / $141.44 / $183.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.65 / $189.20 / $189.20
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.74 / $135.62 / $203.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.51 / $120.51 / $120.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.74 / $96.06 / $155.36