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New York 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
$246.29 / $291.66 / $539.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.29 / $390.44 / $434.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.20 / $683.60 / $1,340.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.79 / $448.79 / $1,126.99
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.29 / $558.38 / $558.38
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.38 / $558.38 / $558.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $418.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $305.72 / $418.79
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $670.20 / $1,507.95
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.07 / $502.65 / $1,206.35
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.77 / $280.77 / $280.77
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.77 / $402.93 / $480.60
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $670.20
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $399.29 / $998.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.90 / $402.12 / $603.41
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$402.93 / $402.93 / $418.73
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.77 / $402.93 / $428.12