go back

Indiana 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
$451.56 / $451.56 / $948.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.41 / $451.56 / $469.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.58 / $849.21 / $948.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.36 / $510.00 / $688.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.63 / $1,043.72 / $1,328.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.51 / $1,043.72 / $1,280.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $948.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $973.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $469.14 / $633.97