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Wisconsin rates for HCPCS L6628

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

Facilitymedian $708 · 10th–90th $575$1,2880%50%10th90th$708Professionalmedian $468 · 10th–90th $269$1,0470%20%10th90th$468$0.5$2.0$10.0$50.0$200.0$1.0K

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
$346.74 / $346.74 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $346.74 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $645.65 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $1,621.81 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $1,000.00 / $1,318.26
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $562.34 / $870.96
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $630.96 / $831.76
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $691.83 / $3,019.95
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $416.87 / $776.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $295.12
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,096.48
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $794.33 / $1,380.38
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,047.13 / $1,819.70
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $1,380.38 / $3,090.30
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $645.65 / $3,801.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $436.52 / $707.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $346.74 / $588.84