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Maine 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
$390.44 / $601.84 / $601.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.77 / $1,029.70 / $1,908.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.69 / $427.69 / $670.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $656.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $305.72 / $418.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.51 / $723.51 / $723.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.15 / $601.84 / $601.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.20 / $515.23 / $1,237.33