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Oklahoma 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
$159.59 / $159.59 / $159.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.59 / $182.39 / $184.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.62 / $325.70 / $325.70
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 / $429.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $223.41 / $1,722.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.93 / $217.90 / $376.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.93 / $175.89 / $248.40