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Maryland 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
Professional
Modifier
Low / Median / High Price
$355.52 / $413.73 / $701.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.00 / $513.00 / $576.44
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 / $385.98 / $528.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.27 / $843.24 / $1,214.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.85 / $435.16 / $667.09
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.31 / $485.31 / $590.27