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Maine rates for HCPCS L7404

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.14 / $441.09 / $441.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.49 / $754.66 / $1,398.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.51 / $382.51 / $491.67
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 / $316.87 / $434.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.25 / $530.25 / $530.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.75 / $441.09 / $441.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.41 / $336.55 / $751.38