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California 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 $389 · 10th–90th $302–$1,7780%20%10th90th$389Professionalmedian $417 · 10th–90th $316–$2,9510%20%10th90th$417$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
$398.11 / $398.11 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $398.11 / $3,019.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $389.05 / $1,737.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $426.58 / $1,071.52
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $1,148.15 / $1,819.70
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,445.44 / $2,951.21
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
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $524.81 / $954.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $724.44 / $1,230.27
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $3,548.13
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $5,011.87 / $5,011.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $724.44 / $1,000.00
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $691.83
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $1,479.11 / $1,479.11
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $549.54 / $724.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $446.68 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $851.14