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Indiana rates for HCPCS L6694

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

Facilitymedian $977 · 10th–90th $447–$1,0720%50%10th90th$977Professionalmedian $468 · 10th–90th $380–$7410%20%40%10th90th$468$1.0$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $446.68 / $676.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $977.24 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $512.86 / $912.01
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $1,122.02 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $1,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $616.60 / $776.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $478.63 / $676.08