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Utah 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 $501 · 10th–90th $214–$7590%20%40%10th90th$501Professionalmedian $550 · 10th–90th $214–$3,3880%5%10%10th90th$550$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $398.11 / $3,388.44
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
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $549.54 / $707.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $758.58 / $758.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $537.03 / $812.83
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $758.58 / $776.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $776.25 / $870.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $436.52 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $602.56