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Iowa 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
$272.14 / $309.89 / $309.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.97 / $198.52 / $312.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $404.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.04 / $429.00 / $536.25
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.49 / $383.27 / $469.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.79 / $478.62 / $1,722.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.01 / $230.35 / $503.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$403.80 / $404.99 / $502.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.70 / $473.08 / $773.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.49 / $196.15 / $482.52
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.81 / $360.81 / $360.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.04 / $360.81 / $360.81