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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
$102.33 / $102.33 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $186.21 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $245.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $263.03 / $338.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $316.23 / $549.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $257.04 / $371.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $363.08 / $371.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $371.54 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $208.93 / $239.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $158.49 / $239.88