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Maine rates for HCPCS L6629

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $112.20 / $275.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $213.80 / $245.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $131.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $112.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $158.49 / $190.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $123.03 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $104.71 / $114.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $131.83 / $186.21