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Washington 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 $741 · 10th–90th $468$1,7780%20%10th90th$741Professionalmedian $525 · 10th–90th $324$1,0720%10%20%10th90th$525$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
$467.74 / $467.74 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $660.69
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $691.83 / $691.83
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $812.83
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $1,000.00 / $2,041.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $870.96 / $1,548.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $549.54 / $602.56
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $724.44 / $741.31
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,047.13 / $1,445.44
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $691.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $691.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $1,096.48 / $1,096.48
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $446.68 / $630.96
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $512.86 / $1,096.48