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Arkansas rates for HCPCS L6895

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.51 / $372.51 / $424.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.66 / $372.51 / $372.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.58 / $765.77 / $850.85
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.02 / $743.02 / $751.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.02 / $743.02 / $743.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $536.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $523.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.90 / $334.36 / $515.23