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Georgia 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
$173.49 / $173.49 / $491.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.49 / $208.93 / $277.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.48 / $583.07 / $1,528.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.42 / $346.29 / $664.88
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.66 / $354.01 / $770.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.01 / $354.01 / $354.01
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.52 / $416.48 / $879.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.52 / $207.77 / $342.78