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South Carolina 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
$335.96 / $335.96 / $335.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.85 / $335.96 / $558.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.00 / $548.41 / $796.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.48 / $418.79 / $462.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $418.79 / $451.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.19 / $538.00 / $1,113.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.00 / $422.00 / $454.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.63 / $374.66 / $503.78