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Arizona 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
$91.33 / $122.49 / $151.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.45 / $258.16 / $466.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.65 / $238.20 / $324.55
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 / $124.21 / $279.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.75 / $181.87 / $1,135.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.05 / $101.84 / $156.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.05 / $101.84 / $153.41