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Louisiana 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
$334.84 / $355.45 / $504.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.25 / $355.45 / $515.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$539.25 / $921.22 / $1,294.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.75 / $439.87 / $439.87
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $444.49 / $444.49
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 / $315.07 / $454.94