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South Carolina 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
$1,230.27 / $1,230.27 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,818.38 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $3,235.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $1,819.70
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,041.74 / $4,365.16
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $1,862.09 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $1,905.46