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Oklahoma 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
$265.82 / $265.82 / $265.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.82 / $303.79 / $303.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.49 / $542.49 / $542.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $444.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $372.11 / $2,994.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.23 / $379.06 / $627.17
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 / $295.31 / $432.10