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Washington 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 $912 · 10th–90th $562–$2,1380%20%10th90th$912Professionalmedian $617 · 10th–90th $380–$1,2880%10%20%10th90th$617$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
$562.34 / $977.24 / $1,318.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $478.63 / $794.33
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $831.76 / $831.76
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $954.99
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $1,202.26 / $2,398.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $1,047.13 / $1,862.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $660.69 / $724.44
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $851.14 / $891.25
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,258.93 / $1,737.80
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $831.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $954.99
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $1,318.26 / $1,318.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $537.03 / $758.58
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $616.60 / $1,318.26