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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$288.40 / $389.05 / $1,202.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,584.89 / $1,819.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $416.87 / $831.76
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $512.86 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $660.69