go back

Utah rates for HCPCS L6691

Upper extremity addition, removable insert, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $245.47 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $295.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $302.00 / $389.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $363.08 / $630.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $295.12 / $446.68
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $416.87 / $489.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $426.58 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $275.42 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $208.93 / $309.03