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Minnesota 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
$201.95 / $201.95 / $201.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.74 / $201.95 / $201.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.81 / $257.35 / $339.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.89 / $229.05 / $241.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $743.84 / $2,065.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.38 / $296.14 / $354.81
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.61 / $713.68 / $1,626.74
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.38 / $279.38 / $287.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.72 / $241.11 / $1,135.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.90 / $113.73 / $242.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.90 / $113.94 / $424.26