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Indiana 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
$5,141.60 / $5,141.60 / $10,803.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,973.47 / $5,244.44 / $5,347.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,534.99 / $9,669.39 / $10,803.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,412.74 / $5,623.53 / $7,760.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,102.84 / $11,884.17 / $16,174.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,183.21 / $11,884.17 / $14,585.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,261.93 / $7,261.93 / $10,803.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,301.21 / $5,301.21 / $11,082.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,075.66 / $5,389.89 / $7,218.78