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Missouri 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
$346.74 / $512.86 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $398.11 / $1,122.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $2,754.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $446.68 / $724.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $467.74 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $616.60 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $389.05 / $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
$263.03 / $380.19 / $524.81