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Washington, DC 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
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $199.53 / $269.15
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $281.84
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 / $288.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $575.44 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $199.53 / $309.03