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Hawaii rates for HCPCS L6920

Wrist disarticulation, external power, self-suspended inner socket, removable forearm shell, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,943.60 / $2,943.60 / $2,943.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,687.53 / $7,687.53 / $7,687.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,541.83 / $6,541.83 / $10,644.70
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,677.00 / $10,132.98 / $10,132.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,806.20 / $9,677.00 / $13,547.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,990.47 / $7,687.53 / $10,644.70
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,232.09 / $7,795.19 / $9,210.71