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Texas rates for HCPCS L6628

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

Facilitymedian $490 · 10th–90th $269–$1,3490%10%20%10th90th$490Professionalmedian $324 · 10th–90th $251–$5370%20%10th90th$324$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
$269.15 / $269.15 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $309.03 / $537.03
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $630.96 / $630.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $446.68
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,090.30 / $3,090.30
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,265.80 / $4,265.80
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $501.19 / $812.83
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $331.13 / $660.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $371.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $478.63 / $812.83
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $446.68 / $660.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $354.81 / $436.52
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $630.96 / $630.96