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Minnesota 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 $661–$5,7540%20%40%10th90th$912Professionalmedian $794 · 10th–90th $380–$9120%50%10th90th$794$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
$660.69 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $436.52 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $794.33 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $794.33 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,951.21 / $7,079.46
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,047.13 / $1,174.90
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,951.21 / $5,754.40
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $1,258.93
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $794.33 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $331.13 / $831.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.37 / $436.52 / $1,096.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $426.58 / $1,096.48