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Kansas 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
$676.07 / $676.07 / $676.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.31 / $470.68 / $753.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.54 / $616.37 / $655.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.19 / $647.19 / $647.19
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 / $528.74 / $1,374.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $724.60 / $4,189.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $480.60 / $1,148.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.04 / $448.55 / $616.57