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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
$501.19 / $602.56 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $398.11 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $933.25 / $1,174.90
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $691.83 / $812.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $977.24 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $501.19 / $1,288.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $870.96 / $1,023.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,288.25 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $512.86 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $398.11 / $707.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $758.58 / $758.58