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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
$489.78 / $489.78 / $489.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $489.78 / $2,884.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $933.25 / $1,288.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $831.76 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $446.68 / $776.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $1,905.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,288.25 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $501.19 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $380.19 / $575.44