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Tennessee rates for HCPCS L6695

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.18 / $308.10 / $308.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.18 / $308.10 / $529.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.72 / $640.04 / $640.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.36 / $564.36 / $564.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.98 / $411.98 / $564.36
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.84 / $3,490.81 / $3,722.67
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,773.79 / $3,773.79 / $5,012.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.53 / $354.79 / $502.37