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Indiana 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
$176.08 / $176.08 / $369.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.08 / $180.66 / $184.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.29 / $331.14 / $369.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.37 / $222.31 / $300.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.02 / $406.99 / $554.99
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.49 / $406.99 / $499.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $369.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $379.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.93 / $184.58 / $254.10