go back

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
$162.51 / $166.42 / $276.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.81 / $342.49 / $619.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.02 / $316.02 / $430.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $429.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $198.52 / $1,722.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.04 / $164.90 / $254.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.04 / $164.90 / $248.40