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Alaska rates for HCPCS L6890

Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.95 / $236.95 / $236.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $181.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.75 / $65.75 / $65.75
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.73 / $257.06 / $405.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.75 / $65.75 / $170.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $259.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.78 / $134.99 / $258.74