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Nebraska 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
$450.22 / $450.22 / $450.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.22 / $450.22 / $530.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$620.50 / $682.54 / $689.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $776.59 / $776.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.49 / $776.59 / $1,197.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.70 / $765.37 / $2,994.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.79 / $382.46 / $587.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.32 / $776.59 / $978.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.00 / $907.16 / $1,599.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.26 / $379.06 / $450.97