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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
$498.37 / $498.37 / $498.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.37 / $675.28 / $675.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.47 / $757.26 / $776.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$934.50 / $943.85 / $1,186.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.43 / $537.37 / $3,451.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.89 / $501.53 / $557.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.80 / $503.78 / $906.99