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Oklahoma 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
$287.56 / $287.56 / $287.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.56 / $328.64 / $371.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.85 / $586.85 / $586.85
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 / $418.79 / $418.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $402.53 / $3,451.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.90 / $441.83 / $678.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.90 / $320.39 / $503.66