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Iowa rates for HCPCS L6642

Upper extremity addition, excursion amplifier, lever type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.88 / $291.47 / $291.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.72 / $169.92 / $250.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $225.10 / $352.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.10 / $403.50 / $504.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.77 / $374.94 / $787.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.47 / $411.99 / $1,446.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.90 / $186.33 / $438.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.67 / $352.68 / $422.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.86 / $399.02 / $673.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.21 / $129.04 / $196.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.96 / $170.14 / $420.21
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$314.20 / $314.20 / $314.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.23 / $314.20 / $314.20