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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
$434.32 / $434.32 / $434.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.66 / $325.36 / $434.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.54 / $893.60 / $1,022.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.69 / $448.79 / $448.79
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 / $418.79
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.84 / $580.84 / $580.84
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.63 / $580.84 / $737.22
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.13 / $477.13 / $477.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.22 / $445.81 / $553.98