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Utah rates for HCPCS L6655

Upper extremity addition, standard control cable, extra

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $53.70 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $63.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $66.07 / $85.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $79.43 / $138.04
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $64.57 / $104.71
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $91.20 / $123.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $91.20 / $134.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $58.88 / $67.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $44.67 / $67.61