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Texas 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 $603 · 10th–90th $324$1,9050%10%20%10th90th$603Professionalmedian $380 · 10th–90th $302$6460%20%40%10th90th$380$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
$323.59 / $323.59 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $354.81 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $741.31 / $741.31
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
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,548.13 / $3,548.13 / $3,548.13
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $5,011.87 / $5,011.87
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $645.65 / $1,047.13
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $380.19 / $724.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $562.34
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $630.96 / $1,023.29
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $562.34
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $524.81 / $776.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $407.38 / $512.86
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $741.31 / $741.31