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Maine rates for HCPCS L7401

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.64 / $272.29 / $272.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.58 / $465.87 / $863.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.13 / $236.13 / $303.52
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 / $195.60 / $267.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.33 / $327.33 / $327.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.64 / $272.29 / $272.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.46 / $207.77 / $463.84