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Rhode Island rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $436.52 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,778.28 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $501.19 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $512.86 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $512.86 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $478.63 / $741.31