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Missouri 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
$410.77 / $607.60 / $627.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.77 / $470.68 / $855.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.10 / $944.06 / $4,150.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.65 / $510.00 / $727.69
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 / $563.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.77 / $724.60 / $4,189.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.44 / $480.60 / $754.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.44 / $451.96 / $636.70