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Nebraska 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
$262.85 / $262.85 / $262.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.85 / $262.85 / $309.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.25 / $398.48 / $402.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $453.39 / $453.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.94 / $453.39 / $699.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.51 / $446.85 / $1,928.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.91 / $243.94 / $342.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.06 / $453.39 / $571.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.98 / $535.82 / $934.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.91 / $205.63 / $284.45