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New Hampshire 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 $447–$9550%20%40%10th90th$813Professionalmedian $537 · 10th–90th $347–$7240%20%10th90th$537$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
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $416.87 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $851.14 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $436.52
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 / $407.38 / $562.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $457.09 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $512.86 / $691.83
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02