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Ohio 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 $851 · 10th–90th $447–$1,4130%20%40%10th90th$851Professionalmedian $398 · 10th–90th $302–$6920%20%10th90th$398$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
$389.05 / $389.05 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $380.19 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $851.14 / $1,737.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $478.63 / $1,047.13
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $602.56 / $851.14
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $645.65 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $562.34
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $562.34
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $630.96 / $912.01
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $977.24
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $912.01 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $645.65 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $389.05 / $512.86