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Wisconsin 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 $813 · 10th–90th $724–$1,4790%50%10th90th$813Professionalmedian $550 · 10th–90th $347–$1,2020%10%20%10th90th$550$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
$398.11 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $398.11 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $1,318.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $758.58 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $1,862.09 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $1,148.15 / $1,513.56
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $645.65 / $1,000.00
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $776.25 / $954.99
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $794.33 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $478.63 / $891.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $501.19
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,288.25
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $912.01 / $1,584.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,202.26 / $2,089.30
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $1,621.81 / $3,715.35
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $831.76 / $3,801.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $501.19 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $398.11 / $660.69