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Virginia 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
$107.67 / $107.67 / $108.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.63 / $107.67 / $122.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.15 / $204.15 / $216.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.82 / $123.82 / $160.25
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.00 / $109.00 / $139.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.00 / $170.15 / $170.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $170.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.91 / $183.74 / $244.98
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.75 / $128.51 / $238.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.00 / $268.14 / $340.04
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.85 / $153.41 / $255.19
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.85 / $153.41 / $255.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.05 / $101.84 / $156.94