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Michigan 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
$457.09 / $457.09 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $398.11 / $602.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $2,454.71 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $812.83 / $851.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
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 / $416.87 / $933.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,548.82 / $1,698.24
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $630.96 / $977.24
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $416.87 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $645.65 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $380.19 / $537.03