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Michigan 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
$392.41 / $392.41 / $392.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.01 / $392.41 / $392.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,040.00 / $2,072.08 / $3,773.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.76 / $687.12 / $927.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.74 / $427.86 / $446.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.70 / $549.70 / $549.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.49 / $444.49 / $796.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.41 / $496.54 / $496.54
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.41 / $496.54 / $772.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $206.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.04 / $328.49 / $478.08