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Idaho 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
$302.00 / $457.09 / $630.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $724.44 / $1,202.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $831.76 / $831.76
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $616.60 / $831.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $724.44 / $758.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $645.65
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $724.44 / $724.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $537.03 / $831.76
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $758.58 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $446.68 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $331.13 / $512.86