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Kentucky 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
$406.16 / $422.41 / $422.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.74 / $444.73 / $505.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.27 / $853.44 / $896.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.17 / $481.70 / $510.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.08 / $1,203.34 / $1,518.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.77 / $1,091.17 / $1,408.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $1,029.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $4,314.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.84 / $513.22 / $641.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.85 / $425.77 / $612.29