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Arkansas 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
$488.74 / $488.74 / $488.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $488.74 / $488.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.09 / $1,004.68 / $1,116.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.24 / $843.24 / $853.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.24 / $843.24 / $843.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $703.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $686.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $438.68 / $616.57