go back

Alaska rates for HCPCS L6694

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.02 / $880.02 / $880.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $528.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $563.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $258.31 / $258.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.77 / $954.71 / $1,507.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $258.31 / $528.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $563.66 / $1,007.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.72 / $501.37 / $960.95