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Massachusetts rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $331.13 / $588.84
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $645.65 / $3,090.30
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $501.19 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $575.44 / $575.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $436.52
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $870.96
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $645.65 / $3,090.30
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $501.19 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $446.68 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $446.68 / $575.44