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Wisconsin rates for HCPCS L6890

Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment

Facilitymedian $245 · 10th–90th $214$4470%20%40%10th90th$245Professionalmedian $174 · 10th–90th $100$3720%20%10th90th$174$0.2$1.0$5.0$20.0$100.0$500.0

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
$120.23 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $120.23 / $194.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $407.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $229.09 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $562.34 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $346.74 / $467.74
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $204.17 / $302.00
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $323.59 / $407.38
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $239.88 / $1,148.15
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $144.54 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $151.36
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $275.42 / $478.63
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $371.54 / $645.65
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $489.78 / $1,288.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $251.19 / $1,318.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $154.88 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $125.89 / $199.53