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Massachusetts 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
$413.73 / $413.73 / $413.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.73 / $413.73 / $701.74
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.18 / $2,672.01 / $4,467.28
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.13 / $682.76 / $924.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.37 / $840.16 / $840.16
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 / $1,099.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.66 / $766.66 / $804.99
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.13 / $705.13 / $705.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,926.15 / $4,467.28 / $4,467.28
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.88 / $506.15 / $924.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.39 / $506.15 / $841.68