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Maine rates for HCPCS L6026

Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,218.58 / $3,419.82 / $3,419.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,516.09 / $5,851.01 / $10,845.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,246.42 / $3,246.42 / $3,443.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,323.97 / $3,323.97 / $3,323.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,426.50 / $2,426.50 / $3,323.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,111.17 / $4,111.17 / $4,111.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,025.34 / $3,419.82 / $3,419.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.79 / $3,382.48 / $5,825.58