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Ohio rates for HCPCS L6697

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L6694 or L6695)

Facilitymedian $1,698 · 10th–90th $933$2,8180%20%40%10th90th$1,698Professionalmedian $813 · 10th–90th $676$1,4130%20%10th90th$813$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
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$776.25
Typical High
$1,318.26
Aetna
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$776.25
Typical High
$1,288.25
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$1,698.24
Typical High
$3,467.37
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$977.24
Typical High
$2,089.30
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,348.96
Typical High
$1,348.96
CareSource
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$1,348.96
Typical High
$1,905.46
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,445.44
Typical High
$2,137.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$1,122.02
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$1,122.02
Molina
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,348.96
Typical High
$1,995.26
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$1,819.70
Typical High
$3,311.31
United
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$1,288.25
Typical High
$1,949.84
United
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$776.25
Typical High
$1,096.48