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Michigan 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
$137.69 / $137.69 / $137.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.67 / $137.69 / $137.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.94 / $727.09 / $1,324.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.05 / $241.11 / $325.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.69 / $132.69 / $156.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.89 / $192.89 / $192.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.15 / $170.15 / $279.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.69 / $174.24 / $174.24
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.77 / $174.24 / $259.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.30 / $178.42 / $205.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.87 / $115.27 / $170.41