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Utah 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 $525 · 10th–90th $257–$9120%20%40%10th90th$525Professionalmedian $646 · 10th–90th $257–$4,0740%5%10%10th90th$646$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $478.63 / $4,073.80
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
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $660.69 / $851.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $912.01 / $912.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $645.65 / $954.99
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $912.01 / $933.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $933.25 / $1,047.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $524.81 / $602.56
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $724.44