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Washington rates for HCPCS L6890

Addition to upper extremity prosthesis, glove for terminal device, any material, prefabricated, includes fitting and adjustment

Facilitymedian $224 · 10th–90th $145$5010%20%10th90th$224Professionalmedian $155 · 10th–90th $95$3240%10%20%10th90th$155$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $251.19 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $123.03 / $199.53
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $218.78 / $218.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $169.82
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $288.40 / $630.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $263.03 / $467.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $169.82 / $186.21
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $218.78 / $223.87
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $223.87 / $223.87
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $323.59 / $446.68
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $218.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $251.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $275.42 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $134.90 / $194.98
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $158.49 / $338.84