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Idaho rates for HCPCS L6694

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.90 / $722.72 / $782.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $589.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $385.98 / $563.66
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $645.46 / $909.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.78 / $816.77 / $859.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $634.49 / $755.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.83 / $839.61 / $1,259.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.83 / $627.62 / $902.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.94 / $400.12 / $634.59