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Colorado 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
$454.70 / $454.70 / $454.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.70 / $454.70 / $662.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$909.40 / $1,021.80 / $1,855.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $510.00 / $550.79
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 / $962.07
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $454.70 / $1,213.79
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.31 / $258.31 / $258.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.86 / $1,136.75 / $1,800.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.94 / $400.12 / $616.57