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Indiana 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
$1,436.73 / $1,436.73 / $3,018.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.73 / $1,474.09 / $1,502.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,384.94 / $2,701.94 / $3,018.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,512.49 / $1,647.60 / $2,273.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,276.44 / $3,320.82 / $4,528.39
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,566.09 / $3,320.82 / $4,075.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $1,952.91 / $3,018.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,952.91 / $3,096.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.96 / $1,506.11 / $2,073.29