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Utah rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Facilitymedian $417 · 10th–90th $214–$6920%20%40%10th90th$417Professionalmedian $501 · 10th–90th $214–$2,8840%20%10th90th$501$50.0$100.0$200.0$500.0$1.0K$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $398.11 / $2,884.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $416.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $501.19 / $645.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $691.83 / $691.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $776.25
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $691.83 / $741.31
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $691.83 / $912.01
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $338.84 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $331.13 / $512.86