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Wyoming 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
Professional
Modifier
Low / Median / High Price
$109.07 / $109.07 / $191.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.02 / $213.02 / $213.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.02 / $213.02 / $213.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.15 / $170.15 / $299.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.21 / $124.21 / $170.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.05 / $135.79 / $156.94