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Montana rates for HCPCS L6628

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

Facilitymedian $741 · 10th–90th $468$9330%20%10th90th$741Professionalmedian $447 · 10th–90th $186$9330%10%10th90th$447$100.0$200.0$500.0$1.0K$2.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $426.58 / $588.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $812.83 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $812.83 / $812.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $741.31 / $1,445.44
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $741.31 / $1,445.44
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $588.84 / $891.25
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $602.56 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $436.52 / $457.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $288.40 / $446.68