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Nebraska 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
$573.37 / $573.37 / $573.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.37 / $573.37 / $676.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.23 / $869.25 / $878.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $989.01 / $989.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.74 / $989.01 / $1,525.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.36 / $974.73 / $4,189.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.31 / $528.74 / $747.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$986.12 / $989.01 / $1,246.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.00 / $1,168.83 / $2,037.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.31 / $448.55 / $616.57