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Maine rates for HCPCS L6624

Upper extremity addition, flexion/extension and rotation wrist unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,938.87 / $2,988.67 / $2,988.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,946.73 / $5,113.35 / $9,478.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,591.81 / $2,591.81 / $3,331.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,941.06 / $2,941.06 / $2,941.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,146.96 / $2,146.96 / $2,941.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,592.86 / $3,592.86 / $3,592.86
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,498.61 / $2,988.67 / $2,988.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,561.19 / $2,213.83 / $5,091.12