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Nebraska 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
$173.58 / $173.58 / $173.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.58 / $173.58 / $204.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.24 / $263.16 / $265.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $299.41 / $299.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.15 / $299.41 / $461.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.37 / $295.08 / $1,135.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.84 / $135.79 / $226.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.54 / $299.41 / $377.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.19 / $349.76 / $591.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.45 / $135.79 / $168.37