go back

North Carolina 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
$562.34 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $457.09 / $602.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,122.02 / $1,513.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $575.44 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $416.87 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $537.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $338.84 / $501.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $616.60 / $1,071.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $501.19 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $371.54 / $524.81
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $5,011.87