go back

Maine rates for HCPCS L7403

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $223.87 / $660.69
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
$269.15 / $269.15 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $288.40
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 / $660.69
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