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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
$342.50 / $342.50 / $342.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.13 / $342.50 / $504.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$684.99 / $769.65 / $1,397.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.79 / $448.79 / $484.69
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 / $305.72 / $821.40
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.86 / $373.66 / $856.24
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.86 / $215.86 / $215.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.04 / $856.24 / $1,356.28
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 / $515.23