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California rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.40 / $401.40 / $2,261.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.14 / $401.40 / $2,261.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.82 / $1,131.22 / $2,487.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.13 / $424.98 / $735.33
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $927.88 / $1,656.93
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,039.86 / $2,422.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $776.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $411.98 / $581.29
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.94 / $502.73 / $862.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.23 / $548.60 / $1,191.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,605.08 / $3,722.67 / $3,722.67
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,773.79 / $3,773.79 / $5,012.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.07 / $1,502.07 / $1,502.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.25 / $710.05 / $794.34
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $564.36 / $690.07
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.26 / $1,479.26 / $1,479.26
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.94 / $626.98 / $628.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.85 / $387.51 / $744.59