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Maine rates for HCPCS L7404

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

Facilitymedian $776 · 10th–90th $437–$8910%20%10th90th$776Professionalmedian $389 · 10th–90th $288–$6610%10%10th90th$389$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $354.81 / $1,000.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $776.25 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $436.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $691.83
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $380.19 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $398.11 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $562.34 / $575.44