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Illinois rates for HCPCS L6696

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.96 / $785.96 / $785.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.14 / $785.96 / $1,302.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,896.87 / $3,209.17 / $13,663.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,206.85 / $1,206.85 / $1,206.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$886.63 / $886.63 / $1,738.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.24 / $886.63 / $1,840.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,429.18 / $1,850.00 / $2,234.98
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,064.37 / $2,064.37 / $2,064.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.46 / $1,280.66 / $1,344.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.79 / $792.23 / $1,402.82