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Ohio 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
$180.66 / $180.66 / $458.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.08 / $180.66 / $248.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.29 / $292.29 / $292.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.42 / $406.99 / $1,054.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.37 / $206.65 / $480.98
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.49 / $314.49 / $314.49
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.49 / $369.99 / $499.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.81 / $334.82 / $792.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $435.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $307.63
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $239.35 / $239.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.05 / $184.58 / $254.10