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Massachusetts 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
$98.64 / $98.64 / $98.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.64 / $100.03 / $171.61
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.03 / $432.35 / $1,292.90
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.84 / $161.53 / $220.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.56 / $130.56 / $387.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.59 / $189.76 / $189.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.56 / $165.91 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $279.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.78 / $182.78 / $191.92
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.69 / $129.69 / $129.69
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.45 / $1,292.90 / $1,292.90
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.18 / $120.66 / $220.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.04 / $120.66 / $220.46