go back

West Virginia 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
$364.35 / $364.35 / $364.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.35 / $364.35 / $434.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.15 / $1,003.08 / $1,300.29
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.96 / $525.70 / $901.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$418.79 / $418.79 / $880.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $3,555.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.69 / $467.07 / $581.54