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Massachusetts rates for HCPCS L7400

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $158.49 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $181.97 / $323.59
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $354.81 / $1,737.80
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $275.42 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $323.59 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $239.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $478.63
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $354.81 / $1,737.80
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $281.84 / $407.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $251.19 / $446.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $245.47 / $316.23