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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
$309.03 / $446.68 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $398.11 / $660.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,819.70 / $2,818.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $630.96 / $933.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $912.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $758.58 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $467.74 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $371.54 / $741.31