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Rhode Island rates for HCPCS L6628

Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.31 / $345.33 / $404.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$965.32 / $1,303.79 / $1,543.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.81 / $358.81 / $600.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$394.91 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $444.49 / $444.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.85 / $411.52 / $567.69