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Wisconsin rates for HCPCS L6895

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

Facilitymedian $832 · 10th–90th $676$1,5140%50%10th90th$832Professionalmedian $589 · 10th–90th $324$1,2300%10%20%10th90th$589$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
$407.38 / $407.38 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $407.38 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $1,348.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $758.58 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $1,905.46 / $4,073.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $1,174.90 / $1,548.82
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $660.69 / $1,023.29
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $977.24 / $1,230.27
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $812.83 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $478.63 / $912.01
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $489.78
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
$588.84 / $933.25 / $1,621.81
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,230.27 / $2,089.30
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $1,621.81 / $3,467.37
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $616.60 / $3,715.35
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $501.19 / $831.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $398.11 / $676.08