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Arizona 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
$295.12 / $398.11 / $1,778.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $407.38 / $851.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,288.25
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 / $416.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $467.74 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $331.13 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $512.86 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $331.13 / $501.19