go back

Washington rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$465.58 / $1,056.86 / $1,103.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.90 / $465.58 / $1,103.42
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.34 / $1,364.32 / $3,490.81
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.23 / $627.34 / $3,773.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $411.98 / $564.36
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.52 / $757.40 / $1,963.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.41 / $769.40 / $1,417.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.31 / $549.24 / $604.16
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.79 / $716.44 / $757.79
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.16 / $569.16 / $569.16
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.34 / $804.60 / $1,399.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$681.92 / $699.65 / $699.65
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.16 / $608.97 / $788.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.42 / $502.37 / $636.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.98 / $608.97 / $608.97