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Connecticut 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
$436.52 / $436.52 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $398.11 / $676.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $912.01 / $1,096.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $446.68 / $457.09
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 / $309.03
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $616.60 / $758.58
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $309.03 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $446.68 / $575.44