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Virginia 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
$347.16 / $347.16 / $350.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.94 / $347.16 / $350.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$658.25 / $658.25 / $699.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.65 / $349.65 / $460.67
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.00 / $353.00 / $449.97
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 / $324.48 / $444.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.78 / $592.42 / $789.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.18 / $404.82 / $738.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.00 / $864.61 / $1,096.43
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.63 / $496.76 / $822.81
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.63 / $496.76 / $822.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.41 / $328.39 / $471.10