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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
$269.15 / $288.40 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $190.55 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $426.58 / $537.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $389.05 / $467.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $467.74 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $251.19 / $630.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $416.87 / $501.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $616.60 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $275.42 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $190.55 / $338.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $363.08 / $363.08