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Arizona rates for HCPCS L7400

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $186.21 / $724.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $218.78 / $457.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $363.08 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $239.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $234.42 / $758.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $165.96 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $257.04 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $165.96 / $251.19