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Illinois rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.34 / $391.34 / $391.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.80 / $391.34 / $597.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.46 / $1,597.86 / $6,803.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.91 / $600.91 / $600.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $824.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $916.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.61 / $874.02 / $1,106.95
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.88 / $1,027.88 / $1,027.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.36 / $637.66 / $669.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.85 / $394.46 / $692.63