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Washington rates for HCPCS L6629

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

Facilitymedian $178 · 10th–90th $120$4470%20%10th90th$178Professionalmedian $129 · 10th–90th $83$2820%10%20%10th90th$129$1.0$5.0$20.0$100.0$500.0

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
$114.82 / $114.82 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $194.98
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $169.82 / $169.82
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $199.53
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 / $112.20
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $245.47 / $501.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $223.87 / $407.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $134.90 / $147.91
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $169.82 / $177.83
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $257.04 / $354.81
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $169.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $199.53
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $239.88 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $117.49 / $165.96
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $125.89 / $269.15