go back

Virginia 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 $724 · 10th–90th $372–$8910%20%40%10th90th$724Professionalmedian $407 · 10th–90th $324–$6920%20%10th90th$407$1.0$5.0$20.0$100.0$500.0$2.0K$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
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $371.54 / $588.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $758.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $891.25
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $562.34 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $724.44 / $1,000.00
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $478.63 / $478.63
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $512.86 / $831.76
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $416.87 / $467.74
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $616.60 / $2,089.30
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $616.60 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $501.19 / $912.01
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $346.74 / $549.54