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Utah rates for HCPCS L6677

Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.04 / $103.04 / $103.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.04 / $113.24 / $1,008.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.66 / $231.66 / $231.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.11 / $231.66 / $246.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.87 / $264.31 / $343.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$317.02 / $353.56 / $353.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.33 / $253.44 / $380.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.11 / $159.61 / $228.97