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South Carolina 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
$4,823.79 / $4,823.79 / $4,823.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,491.89 / $4,823.79 / $8,025.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,240.00 / $7,679.57 / $11,429.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,802.39 / $7,261.93 / $8,017.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,301.21 / $5,301.21 / $6,838.66
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,798.37 / $7,724.00 / $16,934.59
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,063.00 / $6,063.00 / $6,515.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,586.34 / $5,331.52 / $6,951.12