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Utah rates for HCPCS L6675

Upper extremity addition, harness, (e.g., figure of eight type), single cable design

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $45.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $81.28 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $104.71 / $138.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $125.89 / $218.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $102.33 / $154.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $144.54 / $147.91
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $147.91 / $177.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $91.20 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $72.44 / $107.15