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Washington rates for HCPCS L6628

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

Facilitymedian $692 · 10th–90th $447–$1,5140%20%10th90th$692Professionalmedian $447 · 10th–90th $269–$9330%10%20%10th90th$447$1.0$5.0$20.0$100.0$500.0$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
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $371.54 / $588.84
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $676.08 / $676.08
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $776.25
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $812.83 / $1,949.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $812.83 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $537.03 / $588.84
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $676.08 / $741.31
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $691.83 / $758.58
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $1,023.29 / $1,380.38
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $676.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $676.08 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $776.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $776.25 / $933.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $380.19 / $549.54
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $501.19 / $1,071.52