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Oklahoma 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
$1,202.26 / $1,202.26 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,412.54 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,737.80 / $8,511.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,380.38 / $3,630.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $2,818.38 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,258.93 / $1,862.09