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Massachusetts rates for HCPCS L7401

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.64 / $176.64 / $176.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.64 / $186.31 / $321.69
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.72 / $1,140.85 / $1,928.91
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.60 / $300.32 / $394.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.19 / $358.72 / $358.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $267.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $267.94 / $480.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.33 / $327.33 / $343.70
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.82 / $307.82 / $307.82
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.77 / $1,928.91 / $1,928.91
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.93 / $216.10 / $394.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.58 / $225.39 / $394.82