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Missouri 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
$188.31 / $278.54 / $287.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.31 / $215.77 / $392.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.17 / $432.78 / $1,902.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.39 / $248.87 / $333.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $267.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $195.60 / $285.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.31 / $345.23 / $1,928.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.84 / $220.32 / $333.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.22 / $205.63 / $291.88