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Tennessee 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
$244.31 / $249.10 / $249.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.31 / $250.22 / $477.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.58 / $517.48 / $517.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.33 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $324.48 / $444.49
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.78 / $2,994.68 / $3,066.52
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,817.82 / $3,817.82 / $4,312.35
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 / $286.85 / $432.19