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Michigan 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
$1,576.93 / $1,576.93 / $1,576.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.11 / $1,576.93 / $1,576.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,179.35 / $8,326.89 / $15,166.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,623.21 / $2,761.27 / $3,727.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,751.80 / $1,794.83 / $1,804.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,209.02 / $2,209.02 / $2,209.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,786.24 / $1,786.24 / $1,786.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,786.24 / $1,786.24 / $3,201.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,576.93 / $1,995.42 / $1,995.42
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,576.93 / $1,995.42 / $3,105.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.52 / $1,320.07 / $1,896.34