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Colorado 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
$380.19 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $380.19 / $575.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $870.96 / $1,698.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $457.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $776.25 / $1,412.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $776.25 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $380.19 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $288.40 / $436.52