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Missouri rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.71 / $122.34 / $126.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.71 / $115.88 / $172.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.03 / $190.08 / $835.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.68 / $107.08 / $146.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.00 / $113.00 / $113.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.49 / $82.49 / $120.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.71 / $145.91 / $917.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.01 / $98.98 / $187.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.92 / $91.01 / $135.00