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Massachusetts rates for HCPCS L7401

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $204.17 / $363.08
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $398.11 / $1,949.84
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $309.03 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $354.81 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $269.15
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
$354.81 / $354.81 / $537.03
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $398.11 / $1,949.84
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $309.03 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $275.42 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $275.42 / $354.81