go back

Illinois 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
$119.33 / $119.33 / $119.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.17 / $119.33 / $187.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.79 / $486.89 / $2,074.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.24 / $183.24 / $206.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $299.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $279.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.00 / $311.25 / $374.22
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.44 / $313.44 / $313.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.21 / $181.73 / $190.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.30 / $120.29 / $213.00