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Indiana 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
$380.19 / $380.19 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $389.05 / $588.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $831.76 / $1,023.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $446.68 / $812.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $933.25 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $512.86 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $398.11 / $537.03