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Idaho rates for HCPCS L6642

Upper extremity addition, excursion amplifier, lever type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.53 / $234.31 / $260.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$196.14 / $225.10 / $225.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.32 / $225.10 / $231.85
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.06 / $209.50 / $278.73
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.86 / $264.79 / $278.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $205.70 / $244.98
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.07 / $272.20 / $408.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.11 / $195.11 / $292.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.21 / $0.21 / $195.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.38 / $130.21 / $206.50