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Connecticut 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
$194.98 / $194.98 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $204.17 / $363.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $416.87 / $501.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $251.19 / $257.04
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 / $194.98
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $288.40 / $407.38
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $245.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $199.53 / $281.84