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Maine rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $223.87 / $676.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $512.86 / $588.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $316.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $457.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $275.42 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $263.03 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $302.00 / $416.87