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Washington, DC 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
$449.46 / $449.46 / $449.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.46 / $449.46 / $449.46
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.00 / $513.00 / $576.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $385.98 / $385.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.11 / $548.11 / $1,673.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.45 / $420.68 / $595.97