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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
$3,981.07 / $3,981.07 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,570.88 / $5,248.07 / $9,120.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $7,244.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,248.07 / $10,964.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $5,888.44 / $28,840.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $5,248.07 / $12,302.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $7,413.10 / $10,715.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,466.84 / $6,918.31