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Tennessee 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
$362.63 / $369.74 / $369.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.63 / $369.74 / $635.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.49 / $768.10 / $768.10
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.67 / $4,189.10 / $4,467.28
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,528.81 / $4,528.81 / $6,015.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.85 / $425.77 / $602.86