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Maryland rates for HCPCS L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,264.41 / $1,444.86 / $2,355.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,771.93 / $1,771.93 / $2,014.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $1,952.91 / $1,952.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,425.62 / $1,952.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,062.59 / $2,946.56 / $4,243.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.29 / $1,543.51 / $2,331.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.91 / $1,631.91 / $2,062.59