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Illinois rates for HCPCS L6621

Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,412.54 / $2,754.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $5,370.32 / $19,054.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $3,019.95
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,311.31 / $3,981.07
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $2,187.76 / $3,981.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,380.38 / $2,137.96