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Tennessee 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
$86.74 / $88.44 / $88.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.74 / $96.88 / $171.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.11 / $153.11 / $153.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.63 / $183.74 / $183.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.12 / $170.15 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $170.15
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$405.06 / $1,135.98 / $1,292.90
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.51 / $1,306.51 / $2,041.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.90 / $101.84 / $153.44