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Michigan 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
$236.53 / $236.53 / $236.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.11 / $236.53 / $236.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.88 / $1,248.97 / $2,274.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.46 / $414.17 / $559.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.80 / $269.20 / $270.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.34 / $331.34 / $331.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $267.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.54 / $267.94 / $480.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.53 / $299.31 / $299.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.53 / $299.31 / $465.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.51 / $306.49 / $352.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.84 / $198.00 / $292.70