go back

Montana 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 $891 · 10th–90th $562–$1,1220%20%40%10th90th$891Professionalmedian $562 · 10th–90th $302–$1,0470%10%20%10th90th$562$100.0$200.0$500.0$1.0K$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
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $524.81 / $776.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $954.99 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$524.81 / $954.99 / $954.99
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $891.25 / $1,737.80
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $891.25 / $1,737.80
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $851.14 / $1,230.27
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $724.44 / $954.99
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $602.56 / $630.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $398.11 / $616.60