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Michigan 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 $912 · 10th–90th $447–$3,1620%10%20%10th90th$912Professionalmedian $407 · 10th–90th $309–$7940%20%10th90th$407$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
$446.68 / $446.68 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $389.05 / $537.03
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,398.83 / $4,570.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $831.76
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $562.34 / $831.76
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $1,513.56 / $1,698.24
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $630.96 / $977.24
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $562.34 / $660.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $645.65 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $371.54 / $524.81