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Wisconsin rates for HCPCS L6629

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

Facilitymedian $240 · 10th–90th $195$4370%20%40%10th90th$240Professionalmedian $145 · 10th–90th $85$3390%20%10th90th$145$0.2$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
$117.49 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $114.82 / $186.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $223.87 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $549.54 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $338.84 / $457.09
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $194.98 / $295.12
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $263.03 / $316.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $234.42 / $912.01
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $131.83 / $263.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $158.49
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $269.15 / $467.74
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $354.81 / $549.54
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $478.63 / $1,000.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $165.96 / $1,096.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $131.83 / $239.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $117.49 / $194.98