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Massachusetts rates for HCPCS L7403

Addition To Upper Extremity Prosthesis Below Elbow/Wrist Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.59 / $189.59 / $189.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.59 / $199.97 / $345.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.21 / $1,224.41 / $2,070.19
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.13 / $322.33 / $423.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.54 / $384.98 / $384.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $515.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.31 / $351.31 / $368.88
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.40 / $330.40 / $330.40
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$902.52 / $2,070.19 / $2,070.19
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.49 / $231.94 / $423.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.46 / $257.04 / $423.73