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Georgia 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
$355.52 / $355.52 / $1,007.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.52 / $478.65 / $568.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$853.44 / $1,194.82 / $3,132.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.72 / $709.62 / $1,362.47
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$716.75 / $806.51 / $1,578.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.42 / $725.42 / $725.42
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 / $1,071.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.61 / $853.44 / $1,797.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.29 / $425.77 / $702.44