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Alaska rates for HCPCS L6895

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $457.09 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $446.68
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $562.34 / $616.60
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $724.44 / $2,089.30
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $645.65
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $616.60 / $645.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $676.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $416.87 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $1,584.89