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Missouri 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
$168.21 / $248.81 / $256.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.21 / $192.74 / $350.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.17 / $386.58 / $1,699.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.94 / $222.31 / $298.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $174.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.21 / $308.38 / $1,722.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.41 / $196.81 / $297.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.41 / $184.58 / $261.08