go back

Missouri 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
$342.32 / $506.34 / $522.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.32 / $392.24 / $713.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.26 / $786.72 / $3,458.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.37 / $424.98 / $698.42
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 / $411.98 / $581.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.32 / $603.82 / $3,490.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.85 / $400.49 / $628.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.85 / $376.69 / $550.65