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Idaho 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
$422.17 / $583.50 / $583.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.63 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $457.82
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $521.66 / $694.14
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.73 / $659.43 / $694.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $512.27 / $610.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.80 / $677.87 / $1,016.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.90 / $506.72 / $728.85
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 / $463.82