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Oklahoma 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
$377.28 / $377.28 / $377.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.28 / $431.17 / $431.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.90 / $769.95 / $769.95
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 / $528.74 / $528.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$258.31 / $528.13 / $4,189.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $528.73 / $890.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.75 / $419.12 / $602.72