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Louisiana 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
$396.01 / $420.38 / $597.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.67 / $420.38 / $609.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$637.76 / $1,089.52 / $1,531.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.94 / $520.23 / $520.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $564.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.28 / $365.55 / $513.79