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North Dakota 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
$557.76 / $557.76 / $557.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.32 / $575.54 / $575.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$716.80 / $847.51 / $868.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.50 / $804.47 / $1,011.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.25 / $557.76 / $2,994.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.08 / $430.27 / $610.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.23 / $430.27 / $687.12