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Nationwide rates for HCPCS L6695

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $389.05 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $389.05 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $416.87 / $1,548.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $436.52 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $512.86 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $371.54 / $562.34