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Massachusetts 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
$344.75 / $344.75 / $344.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.75 / $344.75 / $584.79
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.96 / $2,226.60 / $3,722.67
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.27 / $568.95 / $770.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$608.78 / $700.10 / $700.10
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 / $916.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.85 / $638.85 / $670.79
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.61 / $587.61 / $587.61
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,605.08 / $3,722.67 / $3,722.67
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.22 / $421.77 / $770.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.42 / $421.77 / $668.33