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Arizona rates for HCPCS L7401

Addition to upper extremity prosthesis, above elbow disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.94 / $186.31 / $309.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.14 / $383.45 / $693.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.36 / $353.81 / $482.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $267.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $195.60 / $480.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.17 / $222.24 / $1,928.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.84 / $184.60 / $284.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.84 / $184.60 / $278.07