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Illinois 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
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,370.32 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $5,370.32 / $10,232.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,882.50 / $20,892.96 / $74,131.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,128.31 / $8,128.31 / $9,549.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $11,220.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $10,964.78
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,317.64 / $10,715.19 / $13,182.57
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,125.38 / $14,125.38 / $14,125.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $8,709.64 / $15,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.80 / $5,370.32 / $8,128.31