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Mississippi 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
$398.54 / $398.54 / $622.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.08 / $597.07 / $662.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.10 / $551.10 / $551.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.10 / $551.10 / $551.10
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 / $411.98 / $564.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.28 / $354.79 / $513.79