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New Hampshire 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 $955 · 10th–90th $537–$1,1480%10%20%10th90th$955Professionalmedian $631 · 10th–90th $398–$8710%20%10th90th$631$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
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $501.19 / $724.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,023.29 / $1,174.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $524.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $549.54 / $602.56
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $616.60 / $831.76
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $1,348.96