go back

Arizona 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 $646 · 10th–90th $214–$1,5490%10%10th90th$646Professionalmedian $389 · 10th–90th $302–$7240%20%10th90th$389$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
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $389.05 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $851.14 / $1,584.89
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $776.25 / $1,513.56
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 / $562.34
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $501.19 / $1,621.81
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $331.13 / $3,801.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $645.65 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $501.19