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Maine 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
$98.64 / $152.04 / $152.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.78 / $260.13 / $482.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.82 / $130.27 / $169.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.25 / $170.15 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $170.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.78 / $182.78 / $182.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.11 / $152.04 / $152.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.08 / $112.62 / $259.00