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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
$338.84 / $398.11 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,047.13 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $933.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $436.52 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $338.84 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $501.19 / $776.25