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Tennessee 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
$158.07 / $161.16 / $161.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.79 / $161.16 / $276.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.65 / $334.82 / $334.82
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 / $239.35
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.23 / $1,722.99 / $1,722.99
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.87 / $1,862.87 / $2,708.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.73 / $185.59 / $254.10