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Illinois 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
$398.11 / $398.11 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $398.11 / $724.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,548.82 / $5,623.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $851.14
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $691.83 / $933.25
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $645.65 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $398.11 / $602.56