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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$413.73 / $481.70 / $561.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,338.80 / $1,808.16 / $2,140.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.71 / $618.48 / $856.28
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.97 / $540.76 / $787.33