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Maine rates for HCPCS L7402

Addition To Upper Extremity Prosthesis Shoulder Disarticulation/Interscapular Thoracic Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $294.05 / $294.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.31 / $503.09 / $932.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.00 / $255.00 / $327.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $318.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $232.40 / $318.35
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.50 / $353.50 / $353.50
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.83 / $294.05 / $294.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.60 / $224.35 / $604.54