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Wyoming 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
$342.50 / $342.50 / $599.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.94 / $668.94 / $668.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.94 / $668.94 / $668.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $844.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $305.72 / $418.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.20 / $445.81 / $515.23