go back

Wyoming 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
$378.90 / $378.90 / $663.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$740.03 / $740.03 / $740.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.03 / $740.03 / $740.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $824.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $411.98 / $564.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.35 / $373.79 / $513.79