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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
$383.68 / $383.68 / $806.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.35 / $383.68 / $399.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$636.91 / $721.56 / $806.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.28 / $448.79 / $619.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$604.66 / $886.83 / $1,128.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.28 / $886.83 / $1,088.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $806.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $751.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.90 / $402.20 / $533.15