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Maine rates for HCPCS L6697

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.19 / $1,043.84 / $1,043.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,378.48 / $1,785.95 / $3,310.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.47 / $905.47 / $1,163.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,111.22 / $1,111.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $811.19 / $1,111.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.88 / $1,254.88 / $1,254.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.69 / $1,043.84 / $1,043.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.48 / $796.51 / $1,778.18