go back

New York 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 / $349.02 / $646.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.73 / $413.73 / $505.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$802.02 / $818.06 / $1,604.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $510.00 / $1,336.60
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.42 / $668.20 / $668.20
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.20 / $668.20 / $668.20
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
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $802.02 / $1,804.55
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.13 / $601.52 / $1,443.64
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$454.50 / $454.50 / $454.50
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.50 / $482.18 / $575.13
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $802.02
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $495.69 / $1,213.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $514.74 / $733.56
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.70 / $482.18 / $482.18
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.50 / $482.18 / $512.32