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Idaho rates for HCPCS L7400

Addition To Upper Extremity Prosthesis Below Elbow Elbow/Wrist Disarticulation Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.64 / $303.57 / $303.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.50 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $392.77
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $254.39 / $361.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.02 / $343.07 / $361.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $266.51 / $317.39
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.22 / $352.67 / $529.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.79 / $261.85 / $379.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.46 / $164.90 / $261.52