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Indiana 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 $813 · 10th–90th $380–$8910%20%40%10th90th$813Professionalmedian $389 · 10th–90th $324–$6170%20%40%10th90th$389$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
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $380.19 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $812.83 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $426.58 / $758.58
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $933.25 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $831.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $512.86 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $398.11 / $562.34