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Maine rates for HCPCS L6628

Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.31 / $459.83 / $459.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.24 / $786.73 / $1,458.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.65 / $366.91 / $512.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $444.49 / $501.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $324.48 / $444.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.79 / $552.79 / $552.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.44 / $459.83 / $459.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.08 / $432.19 / $783.32