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Alabama 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
Facility
Modifier
Low / Median / High Price
$717.41 / $717.41 / $717.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.36 / $717.41 / $717.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.22 / $577.22 / $577.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $948.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $830.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $425.77 / $616.57