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Alabama rates for HCPCS L6697

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.10 / $1,342.10 / $1,342.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.63 / $1,342.10 / $1,342.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.32 / $1,188.32 / $1,188.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,111.22 / $1,587.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $811.19 / $1,840.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.92 / $796.51 / $1,130.31