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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
$350.71 / $518.76 / $535.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.71 / $401.86 / $730.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.64 / $806.02 / $3,543.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.73 / $448.79 / $621.28
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 / $305.72 / $446.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.71 / $618.65 / $3,451.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.63 / $410.34 / $712.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.63 / $382.96 / $554.98