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California rates for HCPCS L6628

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.33 / $345.33 / $1,658.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.22 / $345.33 / $1,658.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.24 / $881.44 / $1,825.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.25 / $349.65 / $639.02
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $680.71 / $1,215.55
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $762.89 / $1,777.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.93 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $324.48 / $457.82
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.56 / $336.67 / $632.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.99 / $402.49 / $873.97
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,394.85 / $3,066.52 / $3,066.52
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,817.82 / $3,817.82 / $4,312.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,270.05 / $1,270.05 / $1,270.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $508.32 / $619.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $627.26
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.24 / $1,085.24 / $1,085.24
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.56 / $459.98 / $459.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.01 / $291.88 / $580.10