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New Jersey 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
$100.03 / $100.03 / $100.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.17 / $106.52 / $171.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.66 / $170.15 / $272.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $238.34
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.66 / $250.41 / $356.57
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.82 / $272.19 / $272.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.21 / $135.79 / $272.19