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Ohio 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 $1,023 · 10th–90th $525–$1,6980%20%10th90th$1,023Professionalmedian $479 · 10th–90th $363–$8130%20%40%10th90th$479$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
$467.74 / $467.74 / $758.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $446.68 / $724.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,023.29 / $2,089.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $575.44 / $1,258.93
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $724.44 / $1,023.29
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $776.25 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $524.81
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $524.81
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $758.58 / $1,096.48
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,148.15
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,096.48 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $776.25 / $1,096.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $467.74 / $616.60