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Connecticut 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
Facility
Modifier
Low / Median / High Price
$109.72 / $109.72 / $109.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.17 / $109.72 / $118.45
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.96 / $225.75 / $258.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.82 / $123.82 / $130.27
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 / $170.15
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.74 / $146.74 / $146.74
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.74 / $160.59 / $225.75
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.69 / $129.69 / $129.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.95 / $112.62 / $156.94