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Minnesota rates for HCPCS L6628

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

Facilitymedian $759 · 10th–90th $575–$5,0120%20%10th90th$759Professionalmedian $692 · 10th–90th $339–$7940%20%40%10th90th$692$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $407.38 / $575.44
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $691.83 / $891.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $691.83 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,479.11 / $2,570.40 / $6,165.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $912.01 / $1,000.00
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,570.40 / $5,011.87
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $794.33 / $1,071.52
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $691.83 / $3,019.95
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $288.40 / $831.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.57 / $380.19 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $380.19 / $954.99