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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
$1,366.67 / $1,366.67 / $1,366.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.55 / $1,366.67 / $2,265.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,299.25 / $5,581.75 / $23,758.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,098.57 / $2,098.57 / $2,611.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $1,786.24 / $3,022.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.96 / $1,786.24 / $3,201.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,485.14 / $3,228.75 / $3,941.37
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
$3,589.65 / $3,589.65 / $3,589.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.29 / $1,377.57 / $2,418.82