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Kansas 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
$346.74 / $346.74 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $213.80 / $346.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $616.60 / $660.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
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 / $478.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $288.40 / $933.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $204.17 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $331.13 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $204.17 / $281.84