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Maine 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
Professional
Modifier
Low / Median / High Price
$157.79 / $243.23 / $243.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.19 / $416.13 / $771.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.93 / $210.93 / $271.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $239.35
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.39 / $292.39 / $292.39
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.34 / $243.23 / $243.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.05 / $248.45 / $414.32