go back

Illinois 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
$181.97 / $181.97 / $380.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $190.55 / $363.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $724.44 / $2,570.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $407.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $426.58 / $537.03
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $323.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $295.12 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $186.21 / $288.40