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Illinois 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
Facility
Modifier
Low / Median / High Price
$183.12 / $183.12 / $183.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.27 / $183.12 / $303.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.02 / $747.82 / $3,183.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.19 / $281.19 / $281.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $404.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $454.74
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.40 / $425.49 / $517.99
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
$480.99 / $480.99 / $480.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.46 / $322.08 / $338.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.86 / $184.58 / $326.83