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Utah rates for HCPCS L6642

Upper Extremity Addition Excursion Amplifier Lever Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.06 / $84.06 / $84.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.06 / $101.31 / $902.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $225.10 / $225.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.32 / $225.10 / $231.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.12 / $190.53 / $247.68
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228.53 / $254.87 / $254.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $182.69 / $274.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.51 / $172.06 / $173.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.56 / $130.21 / $186.80