go back

Missouri 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
$323.59 / $478.63 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $346.74 / $1,023.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $2,511.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $363.08 / $660.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $446.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $549.54 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $354.81 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $562.34 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $338.84 / $467.74