go back

Hawaii 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 $525 · 10th–90th $437–$7760%20%10th90th$525Professionalmedian $437 · 10th–90th $288–$1,0470%20%10th90th$437$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $416.87 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $912.01 / $1,230.27
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,047.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $1,000.00 / $1,148.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $457.09 / $524.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $512.86 / $1,071.52