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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
$189.59 / $292.23 / $292.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.91 / $499.98 / $926.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.44 / $253.44 / $325.76
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 / $286.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.31 / $351.31 / $351.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.32 / $292.23 / $292.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.66 / $298.52 / $600.80