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Illinois 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
$1,494.20 / $1,494.20 / $1,494.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.86 / $1,494.20 / $2,476.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,607.71 / $6,103.61 / $25,975.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $1,952.91 / $3,304.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,952.91 / $3,499.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,717.04 / $3,320.82 / $4,226.50
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,924.61 / $3,924.61 / $3,924.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.83 / $1,506.11 / $2,644.52