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North Carolina 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
$151.94 / $151.94 / $308.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.33 / $151.94 / $151.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.99 / $302.83 / $372.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.37 / $153.11 / $153.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.28 / $170.15 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $279.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.75 / $151.94 / $229.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.00 / $115.00 / $144.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.60 / $326.60 / $502.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.87 / $102.28 / $159.78
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.29 / $1,292.90 / $1,292.90
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.51 / $1,306.51 / $2,041.43