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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
$389.05 / $389.05 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $389.05 / $676.08
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $912.01 / $3,467.37
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $645.65 / $912.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $1,548.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $794.33 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $512.86 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $489.78
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,174.90
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $912.01 / $3,467.37
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $676.08 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $501.19 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $501.19 / $776.25