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Washington, DC 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
$350.86 / $350.86 / $350.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.86 / $350.86 / $350.86
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.00 / $368.88 / $449.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $324.48 / $324.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.86 / $427.86 / $1,306.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.93 / $328.39 / $465.22