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Oklahoma 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
$3,984.81 / $3,984.81 / $3,984.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,984.81 / $4,554.07 / $5,336.96
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 / $5,301.21 / $12,525.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,978.39 / $5,577.97 / $48,028.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,075.66 / $6,096.46 / $9,401.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,075.66 / $4,439.91 / $6,949.58