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Utah rates for HCPCS L7190

Electronic elbow, adolescent, Variety Village or equal, myoelectronically controlled

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $5,248.07 / $40,738.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $6,760.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $7,079.46 / $9,120.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $8,511.38 / $14,791.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,918.31 / $10,232.93
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,709.64 / $9,772.37 / $10,000.00
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,079.46 / $10,000.00 / $11,748.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $4,677.35 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $4,570.88 / $6,760.83