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Colorado 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
$338.84 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $398.11 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $776.25 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $446.68 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $446.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $691.83 / $1,230.27
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $691.83 / $691.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $446.68 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $331.13 / $512.86