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Illinois 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 $891 · 10th–90th $389–$4,0740%20%10th90th$891Professionalmedian $427 · 10th–90th $316–$8130%20%10th90th$427$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$389.05 / $389.05 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $389.05 / $741.31
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,548.82 / $5,495.41
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $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
$407.38 / $407.38 / $912.01
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $891.25 / $1,122.02
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $630.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $645.65 / $1,096.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $398.11 / $660.69