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Alaska rates for HCPCS L6628

Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.68 / $403.68 / $403.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $457.82
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $185.18 / $185.18
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$437.94 / $659.43 / $691.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $185.18 / $444.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $457.82 / $660.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.80 / $229.98 / $440.80