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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
$380.19 / $512.86 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $380.19 / $588.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,000.00 / $1,380.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
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 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $537.03 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $331.13 / $501.19