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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
$577.21 / $577.21 / $577.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.86 / $401.86 / $642.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$605.96 / $637.85 / $678.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.74 / $669.74 / $669.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $418.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $1,168.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $618.65 / $3,451.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.90 / $439.54 / $980.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.31 / $382.96 / $515.23