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Massachusetts 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
$390.44 / $390.44 / $390.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.44 / $390.44 / $576.88
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$533.92 / $1,636.61 / $3,451.92
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.82 / $543.95 / $872.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$516.88 / $516.88 / $1,535.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.65 / $792.87 / $792.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $516.88 / $626.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $934.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.51 / $723.51 / $759.69
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.13 / $477.13 / $477.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,636.61 / $3,451.92 / $3,451.92
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.36 / $477.66 / $872.66
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 / $477.66 / $751.11