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Utah rates for HCPCS L6895

Addition To Upper Extremity Prosthesis Glove For Terminal Device Any

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $215.86 / $215.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.86 / $217.13 / $1,933.69
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 / $446.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.03 / $500.06 / $650.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.80 / $668.94 / $668.94
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.93 / $479.49 / $719.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.89 / $334.36 / $479.68