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Pennsylvania 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 $1,096 · 10th–90th $380–$1,4450%20%10th90th$1,096Professionalmedian $447 · 10th–90th $363–$7940%20%40%10th90th$447$1.0$10.0$100.0$1.0K$10.0K

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
$380.19 / $1,445.44 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $446.68 / $741.31
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $524.81
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,071.52 / $1,548.82
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $851.14
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $602.56 / $851.14
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $630.96
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $446.68 / $676.08
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $1,148.15 / $1,584.89
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $794.33
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $794.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $1,096.48 / $1,258.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $467.74 / $812.83