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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
$286.14 / $286.14 / $286.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.14 / $301.77 / $521.12
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$585.96 / $1,848.12 / $3,124.60
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.04 / $486.50 / $639.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.83 / $581.10 / $581.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $777.75
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
$530.25 / $530.25 / $556.76
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.68 / $498.68 / $498.68
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,362.19 / $3,124.60 / $3,124.60
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.83 / $350.06 / $639.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.48 / $350.06 / $639.57