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Massachusetts rates for HCPCS L6621

Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,380.38 / $2,454.71
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,630.27 / $12,882.50
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,041.74 / $2,754.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,548.13 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,290.87 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,778.28
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $3,548.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,041.74
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $2,630.27 / $12,882.50
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,089.30 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $1,862.09 / $3,388.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,862.09 / $2,344.23