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Massachusetts 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
$298.31 / $298.31 / $298.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.31 / $298.31 / $483.33
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.45 / $1,244.06 / $3,066.52
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.52 / $456.19 / $666.75
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $394.91 / $1,172.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.07 / $605.79 / $605.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $444.49 / $478.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $796.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.79 / $552.79 / $580.42
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.30 / $365.30 / $365.30
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,394.85 / $3,066.52 / $3,066.52
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.70 / $364.95 / $666.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.70 / $364.95 / $574.98