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Virginia 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
$190.46 / $190.46 / $192.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.88 / $190.46 / $211.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.13 / $361.13 / $383.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.31 / $222.31 / $277.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.70 / $219.70 / $246.87
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.79 / $325.02 / $433.36
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $222.10 / $403.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.22 / $474.35 / $601.53
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.86 / $277.63 / $461.36
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.86 / $277.63 / $461.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.90 / $180.17 / $258.47