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New Jersey 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
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $389.05 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $416.87 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $724.44 / $1,000.00
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $501.19 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $354.81 / $562.34