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Maine 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
Professional
Modifier
Low / Median / High Price
$181.97 / $208.93 / $616.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $478.63 / $549.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $416.87
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $426.58
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $251.19 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $245.47 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $281.84 / $389.05