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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
$302.00 / $398.11 / $630.96
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 / $416.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $758.58 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $501.19 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $380.19 / $588.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $630.96