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Tennessee 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
$316.23 / $316.23 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $371.54 / $630.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $5,011.87 / $5,011.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $446.68 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $363.08 / $501.19