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California 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
$402.53 / $402.53 / $1,933.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.43 / $402.53 / $1,933.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.67 / $1,027.42 / $2,127.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.28 / $448.79 / $749.78
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $793.45 / $1,416.88
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $889.25 / $2,071.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.47 / $418.79 / $418.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $305.72 / $446.44
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.08 / $258.10 / $737.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.12 / $469.14 / $1,018.70
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,354.43 / $3,451.92 / $3,451.92
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,683.44 / $3,683.44 / $5,026.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,373.91 / $1,373.91 / $1,373.91
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $592.51 / $695.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $678.95
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,264.98 / $1,264.98 / $1,264.98
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.08 / $365.64 / $536.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.14 / $334.36 / $652.27