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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
$288.40 / $288.40 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $389.05 / $660.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $851.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $416.87 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $380.19 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $537.03 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $316.23 / $501.19