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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
$344.75 / $401.40 / $467.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.58 / $1,506.75 / $1,783.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.47 / $414.67 / $693.50
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 / $564.36 / $564.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.78 / $478.34 / $656.07