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Louisiana 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
$239.88 / $323.59 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $213.80 / $346.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $616.60 / $870.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
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 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $331.13 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $199.53 / $281.84