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Virginia 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
$1,554.02 / $1,554.02 / $1,570.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.07 / $1,554.02 / $1,619.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,946.56 / $2,946.56 / $3,129.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,647.60 / $1,647.60 / $2,098.30
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,771.93 / $1,771.93 / $2,014.25
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 / $1,952.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,062.59 / $2,651.90 / $3,535.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.59 / $1,812.19 / $3,306.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.00 / $3,870.32 / $4,908.02
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,614.33 / $2,223.73 / $3,602.98
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,614.33 / $2,223.73 / $3,602.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.45 / $1,470.01 / $2,133.87