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Indiana 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
$1,314.11 / $1,314.11 / $2,761.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.11 / $1,348.28 / $1,374.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,181.40 / $2,471.34 / $2,761.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.41 / $1,487.71 / $2,008.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,082.14 / $3,037.40 / $4,141.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,347.08 / $3,037.40 / $3,727.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $1,786.24 / $2,761.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.96 / $1,786.24 / $2,832.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.41 / $1,377.57 / $1,896.34