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Kentucky 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
$180.51 / $198.21 / $206.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.43 / $201.05 / $220.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.26 / $416.48 / $437.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.78 / $222.24 / $248.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.36 / $579.84 / $667.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.66 / $517.71 / $687.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $488.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $267.94 / $1,986.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.19 / $261.20 / $326.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.52 / $207.77 / $282.49