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Indiana 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
$114.75 / $114.75 / $241.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.04 / $114.75 / $119.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.48 / $215.79 / $241.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.62 / $123.82 / $170.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.53 / $255.19 / $337.55
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.94 / $265.22 / $325.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $241.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $247.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.90 / $120.29 / $161.53