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Michigan 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
$6,169.93 / $6,169.93 / $6,169.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,141.60 / $6,169.93 / $6,169.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,352.21 / $32,579.91 / $59,338.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,263.60 / $10,803.79 / $14,585.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,592.69 / $7,008.93 / $7,022.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,643.03 / $8,643.03 / $8,643.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,261.93 / $7,261.93 / $7,261.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,301.21 / $8,983.15 / $15,656.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,169.93 / $7,807.30 / $7,807.30
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,169.93 / $7,807.30 / $12,151.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,795.58 / $7,994.80 / $9,194.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,844.58 / $5,164.89 / $7,732.48