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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
$562.34 / $562.34 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $346.74 / $575.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $851.14 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $1,000.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $575.44 / $3,019.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $380.19 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $933.25 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $426.58 / $776.25