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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
$301.58 / $335.96 / $558.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.95 / $635.63 / $1,149.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.88 / $586.50 / $799.11
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 / $305.72 / $934.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $467.07 / $3,451.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.20 / $334.36 / $515.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.20 / $334.36 / $511.66