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Louisiana 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
$362.22 / $384.51 / $546.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.63 / $384.51 / $557.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.34 / $996.55 / $1,400.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.82 / $475.84 / $475.84
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $418.79
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 / $347.53 / $515.23