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Alaska rates for HCPCS L6695

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism

Facilitymedian $437 · 10th–90th $214–$8130%20%40%10th90th$437Professionalmedian $501 · 10th–90th $380–$1,1480%10%20%10th90th$501$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $467.74 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $1,071.52
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $524.81 / $812.83
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $812.83 / $2,187.76
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $812.83 / $851.14
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $812.83 / $851.14
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $794.33
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $537.03 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $416.87 / $1,621.81