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Arizona 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
$257.22 / $258.74 / $451.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.94 / $545.30 / $985.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.38 / $503.18 / $685.58
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 / $324.48 / $796.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $400.70 / $2,994.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.26 / $286.85 / $442.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.20 / $286.85 / $432.10