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Arkansas 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
$407.27 / $407.27 / $407.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.85 / $407.27 / $407.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.54 / $837.20 / $930.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.69 / $702.69 / $711.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.69 / $702.69 / $702.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $586.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $572.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.28 / $365.55 / $513.79