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California 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
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $223.87 / $1,548.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $213.80 / $912.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $446.68
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $724.44 / $954.99
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $758.58 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $269.15
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $269.15 / $489.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $371.54 / $660.69
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $1,949.84
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,019.95 / $3,019.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $416.87 / $537.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $398.11
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $323.59 / $371.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $245.47 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $407.38