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Missouri 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
$1,372.50 / $2,030.16 / $2,095.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.50 / $1,572.66 / $2,859.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,004.13 / $3,154.34 / $13,867.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,533.45 / $1,647.60 / $2,431.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $1,952.91 / $1,952.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,425.62 / $2,081.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,372.50 / $2,421.08 / $14,058.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,121.21 / $1,605.81 / $2,666.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,143.75 / $1,498.72 / $2,073.29