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Connecticut 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
$331.84 / $331.84 / $331.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.22 / $292.94 / $331.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.13 / $682.75 / $781.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.65 / $349.65 / $366.91
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 / $444.49
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.79 / $443.79 / $443.79
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.74 / $443.79 / $580.34
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.30 / $365.30 / $365.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.94 / $340.61 / $442.02