go back

Minnesota 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
$575.54 / $575.54 / $575.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.00 / $557.76 / $575.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.62 / $687.12 / $956.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.70 / $652.76 / $687.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $2,119.79 / $5,887.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.50 / $844.29 / $1,011.56
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.50 / $2,033.84 / $4,635.85
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.50 / $796.50 / $819.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.74 / $687.12 / $2,994.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.23 / $320.92 / $690.00
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 / $320.79 / $690.00