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Washington, DC 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
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $346.74 / $537.03
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $426.58 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $575.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $1,000.00 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $363.08 / $537.03