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Pennsylvania 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
$91.17 / $91.17 / $352.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.17 / $100.03 / $142.49
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.44 / $204.15 / $204.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $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
$250.41 / $272.19 / $517.16
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.84 / $137.84 / $137.84
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.17 / $91.17 / $352.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.04 / $100.11 / $171.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.30 / $371.20 / $536.29
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $272.19
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $279.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.16 / $141.16 / $194.31
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.16 / $194.31 / $259.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.87 / $122.76 / $184.10