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Missouri 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
$124.36 / $183.95 / $189.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.33 / $142.49 / $259.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.19 / $285.80 / $1,256.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.61 / $123.82 / $220.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $181.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.82 / $218.13 / $1,135.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.53 / $135.79 / $213.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.53 / $135.79 / $181.06