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Maryland rates for HCPCS L6895

Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.85 / $390.44 / $599.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.00 / $416.40 / $507.93
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.11 / $743.02 / $1,069.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.69 / $383.44 / $587.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.55 / $405.55 / $520.11