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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
$390.44 / $402.53 / $529.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,263.43 / $1,706.43 / $2,020.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.68 / $503.15 / $808.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $516.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $418.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.93 / $503.16 / $743.01