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Utah rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Facilitymedian $112 · 10th–90th $56–$2190%20%40%10th90th$112Professionalmedian $148 · 10th–90th $56–$9120%5%10%10th90th$148$50.0$100.0$200.0$500.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $109.65 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $120.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $162.18 / $208.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $218.78 / $218.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $158.49 / $199.53
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $218.78 / $223.87
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $223.87 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $104.71 / $131.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $87.10 / $162.18