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Kansas 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
$645.65 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $398.11 / $602.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $630.96 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
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 / $933.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $537.03 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $407.38 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $616.60 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $380.19 / $512.86