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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
$346.74 / $346.74 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $380.19 / $741.31
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $776.25 / $3,715.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $602.56 / $812.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $707.95 / $707.95
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 / $562.34
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $1,047.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $776.25 / $3,715.35
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $602.56 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $501.19 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $501.19 / $691.83