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Ohio 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
$463.30 / $463.30 / $1,068.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.49 / $463.30 / $607.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$890.96 / $1,043.72 / $2,704.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.36 / $510.00 / $1,233.49
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.51 / $806.51 / $806.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.08 / $948.84 / $1,280.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.75 / $853.96 / $2,031.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $1,029.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $385.98 / $675.47
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.74 / $528.74 / $528.74
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.98 / $528.74 / $528.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.58 / $473.36 / $616.57