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Utah rates for HCPCS L6628

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

Facilitymedian $380 · 10th–90th $186–$7590%20%40%10th90th$380Professionalmedian $550 · 10th–90th $186–$2,5120%10%10th90th$550$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $380.19 / $2,511.89
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
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $562.34 / $724.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $758.58 / $758.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $549.54 / $776.25
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $758.58 / $776.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $776.25 / $851.14
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $288.40 / $436.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $288.40 / $446.68