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Texas 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 $724 · 10th–90th $380–$2,3990%20%10th90th$724Professionalmedian $427 · 10th–90th $363–$7760%20%10th90th$427$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
$380.19 / $416.87 / $933.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $426.58 / $776.25
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $891.25 / $891.25
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
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $4,265.80
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,570.88 / $6,025.60 / $6,025.60
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $776.25 / $1,258.93
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $446.68 / $870.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $676.08
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $724.44 / $1,230.27
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $524.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $630.96 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $489.78 / $616.60
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $891.25 / $891.25