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Minnesota 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
$676.08 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $407.38 / $676.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $812.83 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,019.95 / $7,244.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,071.52 / $1,174.90
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $2,884.03 / $5,623.41
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $1,258.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $812.83 / $1,445.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $338.84 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $446.68 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $380.19 / $933.25