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California rates for HCPCS L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,619.76 / $1,619.76 / $8,501.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.43 / $1,619.76 / $8,501.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.01 / $4,470.47 / $9,353.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,512.49 / $1,647.60 / $2,807.60
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $3,488.47 / $6,229.41
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $3,909.58 / $9,106.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,378.17 / $1,952.91 / $1,952.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,425.62 / $2,081.90
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.05 / $1,890.06 / $3,241.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.94 / $2,062.59 / $4,478.77
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,071.80 / $14,058.21 / $14,058.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,199.11 / $15,199.11 / $22,099.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,221.72 / $6,221.72 / $6,221.72
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.59 / $2,580.11 / $3,034.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,952.91 / $2,804.58
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,561.52 / $5,561.52 / $5,561.52
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,575.05 / $2,357.25 / $2,362.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,266.47 / $1,447.03 / $2,946.56