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Pennsylvania 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 $891 · 10th–90th $316–$1,2020%20%10th90th$891Professionalmedian $380 · 10th–90th $302–$6610%20%40%10th90th$380$1.0$10.0$100.0$1.0K$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
$316.23 / $1,202.26 / $1,202.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $371.54 / $616.60
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $562.34
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $891.25 / $1,288.25
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $501.19 / $724.44
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $524.81
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $316.23
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $371.54 / $602.56
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $912.01 / $1,318.26
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $676.08
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $501.19 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $912.01 / $1,047.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $676.08