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New Jersey 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
$294.73 / $294.73 / $294.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.73 / $376.57 / $573.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $802.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $385.98 / $702.28
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.70 / $737.86 / $1,050.65
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.37 / $802.02 / $802.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.94 / $421.90 / $736.30