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Kentucky 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
$209.00 / $273.64 / $284.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.31 / $322.77 / $366.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.93 / $574.98 / $604.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.39 / $345.33 / $349.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.24 / $810.72 / $1,092.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.98 / $776.22 / $961.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $444.49 / $734.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $3,077.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.48 / $366.44 / $458.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.23 / $294.33 / $442.02