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Arizona 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
$381.79 / $423.22 / $635.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.91 / $891.97 / $1,612.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.27 / $823.03 / $1,121.38
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 / $385.98 / $1,099.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $471.19 / $4,189.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.63 / $400.12 / $616.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.63 / $400.12 / $602.72