go back

New Hampshire 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 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $436.52 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $977.24 / $1,122.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $457.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $446.68 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $478.63 / $776.25
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,288.25