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Nevada 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
$253.92 / $253.92 / $651.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.92 / $352.67 / $651.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$783.72 / $783.72 / $783.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.40 / $424.98 / $891.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $576.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $500.50 / $581.29
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.83 / $626.98 / $1,018.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.07 / $333.42 / $523.66