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Maine rates for HCPCS L6641

Upper extremity addition, excursion amplifier, pulley type

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.71 / $153.69 / $153.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.96 / $262.95 / $487.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.63 / $122.88 / $171.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.98 / $126.98 / $167.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.70 / $92.70 / $126.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.76 / $184.76 / $184.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.50 / $153.69 / $153.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.51 / $120.51 / $120.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.90 / $144.72 / $261.81