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Nebraska 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
$489.54 / $489.54 / $489.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.54 / $489.54 / $577.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.67 / $742.14 / $749.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $844.40 / $844.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.79 / $844.40 / $1,302.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.90 / $832.22 / $3,451.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.26 / $445.81 / $638.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.94 / $844.40 / $1,063.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.10 / $997.93 / $1,739.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.26 / $382.96 / $515.23