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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
$559.20 / $559.20 / $559.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $418.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $446.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $215.86 / $215.86
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.66 / $706.92 / $957.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $215.86 / $418.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $446.44 / $748.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.58 / $318.58 / $610.64