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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
$319.10 / $325.36 / $325.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.43 / $325.36 / $558.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.46 / $675.90 / $675.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.25 / $418.79 / $418.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.72 / $305.72 / $418.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.85 / $3,451.92 / $3,451.92
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,683.44 / $3,683.44 / $5,026.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.73 / $306.73 / $306.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.78 / $374.66 / $503.78