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Georgia 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
Facility
Modifier
Low / Median / High Price
$154.88 / $446.68 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $181.97 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $891.25 / $1,380.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $309.03 / $446.68
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $426.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $380.19 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $251.19 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $186.21 / $363.08