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Georgia 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
$312.85 / $312.85 / $500.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.85 / $434.32 / $500.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$751.00 / $1,051.40 / $2,756.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.38 / $624.44 / $1,198.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$631.57 / $685.28 / $1,389.35
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.35 / $638.35 / $638.35
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 / $418.79 / $895.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.76 / $751.00 / $1,217.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.80 / $374.66 / $618.13