Upper extremity prosthesis excursion amplifier pulley

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Excursion amplifier pulley t

Payers reporting HCPCS L6641

Payer pricing summary

Low

$64

Average

$279

Median

$242

High

$737

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Aetna fee schedule · outpatient · +12 other terms	359	$234	$259	$130	50%	—	$94 – $1.4k
2	UnitedHealthcare fee schedule · outpatient · +13 other terms	356	$230	$223	$54	24%	—	$96 – $697
3	Humana fee schedule · outpatient · +12 other terms	317	$227	$337	$388	115%	—	$114 – $1.8k
4	Blue Cross Blue Shield fee schedule · outpatient · +11 other terms	227	$239	$302	$171	57%	—	$0 – $1.2k
5	WellCare fee schedule · outpatient · +5 other terms	208	$234	$243	$53	22%	—	$193 – $511
6	Devoted fee schedule · outpatient · +3 other terms	165	$198	$226	$21	9%	—	$190 – $267
7	Molina fee schedule · outpatient · +5 other terms	138	$307	$322	$123	38%	—	$121 – $626
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	116	$210	$230	$16	7%	—	$196 – $270
9	Cigna fee schedule · outpatient · +12 other terms	102	$224	$248	$86	35%	—	$190 – $707
10	Anthem fee schedule · outpatient · +6 other terms	80	$198	$304	$327	107%	—	$114 – $1.8k
11	Kaiser fee schedule · outpatient · +6 other terms	64	$202	$345	$251	73%	—	$190 – $1.5k
12	Superior Healthplan fee schedule · outpatient	40	$251	$251	$1	0%	—	$234 – $251
13	Clover fee schedule · outpatient · +3 other terms	37	$257	$239	$24	10%	—	$196 – $262
14	Oscar fee schedule · outpatient · +4 other terms	36	$234	$264	$69	26%	—	$206 – $418
15	Ambetter facility · fee schedule · outpatient · +6 other terms	35	$433	$404	$69	17%	—	$193 – $491
16	Optum fee schedule · outpatient · +3 other terms	33	$196	$292	$140	48%	—	$190 – $597
17	Caresource fee schedule · outpatient · +5 other terms	28	$196	$229	$82	36%	—	$114 – $373
18	Medica facility · fee schedule · outpatient · +5 other terms	22	$247	$223	$60	27%	—	$80 – $398
19	Regence facility · fee schedule · outpatient · +4 other terms	19	$206	$202	$9	4%	—	$175 – $209
20	Amerihealth Caritas fee schedule · outpatient · +1 other terms	18	$236	$234	$4	2%	—	$224 – $236
21	Bcbs Tx fee schedule · outpatient	18	$234	$234	—	—	—	$234 – $234
22	Medicare fee schedule · outpatient · +3 other terms	18	$190	$191	$1	1%	—	$190 – $194
23	Medical Mutual facility · fee schedule · outpatient · +2 other terms	15	$241	$277	$69	25%	—	$131 – $381
24	Bcbs Mn fee schedule · outpatient · +6 other terms	13	$220	$219	$51	23%	—	$107 – $257
25	Wellmark fee schedule · both · +3 other terms	13	$230	$228	$9	4%	—	$176 – $230

Page 1 of 3 · 53 payers