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Illinois rates for HCPCS L6642

Upper extremity addition, excursion amplifier, lever type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.23 / $172.23 / $172.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.79 / $172.23 / $234.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.58 / $704.78 / $2,994.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $225.10 / $352.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.32 / $225.10 / $403.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.98 / $690.56 / $840.68
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.37 / $452.37 / $452.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.59 / $262.27 / $275.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.31 / $172.06 / $196.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.74 / $173.60 / $298.02