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Washington, DC 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
$398.11 / $398.11 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $389.05 / $602.56
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $524.81
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
$489.78 / $1,071.52 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $380.19 / $562.34