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North Dakota 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
$501.19 / $501.19 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $426.58 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $758.58 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $1,174.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $676.08 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $338.84 / $691.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $1,096.48 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $501.19 / $870.96