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Maine 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
$413.73 / $637.74 / $637.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.16 / $1,091.08 / $2,022.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $511.80 / $710.90
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.66 / $766.66 / $766.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.17 / $637.74 / $637.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.93 / $602.86 / $1,086.38