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Iowa 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
$498.37 / $675.28 / $675.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.85 / $402.53 / $657.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $844.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.79 / $934.50 / $1,168.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.97 / $696.20 / $806.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.54 / $997.93 / $3,451.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.98 / $467.07 / $1,048.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.94 / $844.40 / $1,018.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.57 / $986.38 / $1,613.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.37 / $386.42 / $1,006.04
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.29 / $752.29 / $752.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$594.30 / $752.29 / $752.29