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Ohio 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
$117.73 / $117.73 / $342.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.11 / $117.73 / $183.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.40 / $265.22 / $687.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.62 / $123.82 / $313.44
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.94 / $204.94 / $204.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.72 / $241.11 / $325.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.72 / $217.00 / $516.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $279.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $200.48
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $170.15
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $170.15 / $170.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.35 / $179.23 / $234.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.19 / $120.29 / $156.94