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Pennsylvania rates for HCPCS L6628

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

Facilitymedian $676 · 10th–90th $295$1,1480%20%10th90th$676Professionalmedian $331 · 10th–90th $251$5750%20%10th90th$331$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$295.12 / $1,148.15 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $323.59 / $524.81
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $446.68
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $776.25 / $1,122.02
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $436.52 / $676.08
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $295.12
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $338.84 / $501.19
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $776.25 / $1,122.02
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $630.96
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $660.69
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $776.25 / $891.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $354.81 / $588.84