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Connecticut rates for HCPCS L6694

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.23 / $460.23 / $460.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $413.73 / $460.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.83 / $946.88 / $1,083.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $510.00 / $511.80
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 / $528.74
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$615.47 / $615.47 / $615.47
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.30 / $615.47 / $804.85
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.13 / $705.13 / $705.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.50 / $472.40 / $616.57