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Utah rates for HCPCS L7191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $6,606.93 / $47,863.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,309.57 / $6,309.57 / $8,912.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $60.26 / $12,589.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $12,589.25 / $21,379.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,943.28 / $10,232.93 / $12,589.25
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,220.18 / $14,125.38 / $14,454.40
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,232.93 / $14,454.40 / $14,454.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $5,495.41 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $5,495.41 / $8,317.64