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Wisconsin rates for HCPCS L6694

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

Facilitymedian $977 · 10th–90th $871$1,7780%20%40%10th90th$977Professionalmedian $661 · 10th–90th $407$1,4450%20%10th90th$661$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
$478.63 / $478.63 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $478.63 / $776.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,584.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $891.25 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $2,238.72 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $1,380.38 / $1,819.70
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $776.25 / $1,202.26
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,288.25 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $954.99 / $4,168.69
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $575.44 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $602.56
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,096.48 / $1,905.46
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,445.44 / $2,511.89
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $1,905.46 / $4,466.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $776.25 / $4,570.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $602.56 / $977.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $478.63 / $794.33