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Wisconsin 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
$186.64 / $186.64 / $186.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.97 / $186.64 / $312.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.99 / $406.99 / $673.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.99 / $344.09 / $455.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.16 / $791.78 / $791.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $816.49 / $1,543.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $616.21 / $700.24
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $279.95 / $425.49
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.85 / $361.13 / $443.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.28 / $369.99 / $1,722.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.95 / $247.22 / $402.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $235.84
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $279.95 / $425.49
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.85 / $361.13 / $443.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.99 / $569.40 / $989.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $722.64 / $1,722.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $239.35 / $1,862.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.99 / $369.99 / $369.99
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.99 / $369.99 / $369.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.40 / $246.10 / $402.87