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Montana 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 $741 · 10th–90th $525–$9330%20%10th90th$741Professionalmedian $468 · 10th–90th $251–$9330%10%20%10th90th$468$100.0$200.0$500.0$1.0K$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
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $436.52 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $794.33 / $794.33
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $741.31 / $1,445.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $741.31 / $1,445.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $707.95 / $1,023.29
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $602.56 / $794.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $501.19 / $524.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $331.13 / $512.86