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Kentucky 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
$354.81 / $354.81 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $389.05 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $758.58 / $812.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $398.11 / $446.68
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,023.29 / $1,318.26
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $933.25 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $630.96 / $3,548.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $501.19 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $446.68 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $371.54 / $512.86