go back

Idaho 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
$245.89 / $339.85 / $339.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.57 / $267.94 / $267.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $195.60 / $285.63
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.17 / $284.77 / $404.30
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.87 / $384.09 / $404.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $298.37 / $355.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.01 / $394.82 / $592.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.01 / $293.14 / $424.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.68 / $184.60 / $292.77