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Hawaii rates for HCPCS L6925

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,398.34 / $3,398.34 / $3,398.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,762.04 / $8,762.04 / $8,762.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,261.93 / $12,132.56 / $12,132.56
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,029.60 / $11,549.31 / $11,549.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,617.76 / $11,029.60 / $15,441.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,059.89 / $8,762.04 / $12,132.56
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,823.63 / $8,884.76 / $10,498.14