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Iowa 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 $724 · 10th–90th $513–$2,0420%20%10th90th$724Professionalmedian $417 · 10th–90th $295–$7940%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
$549.54 / $588.84 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $389.05 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $912.01 / $1,148.15
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $794.33 / $954.99
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $977.24 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $501.19 / $1,258.93
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $851.14 / $1,023.29
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,258.93 / $1,258.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $758.58 / $1,778.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $398.11 / $707.95
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $741.31 / $741.31