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North Dakota 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
$661.63 / $661.63 / $661.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.63 / $794.75 / $794.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.29 / $1,005.34 / $1,030.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.88 / $1,110.86 / $1,396.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.06 / $661.63 / $4,189.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.30 / $600.17 / $735.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $600.17 / $951.89