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Oklahoma 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
$178.67 / $178.67 / $178.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.67 / $204.19 / $206.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.10 / $364.63 / $364.63
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 / $267.94 / $267.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.17 / $250.09 / $1,928.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.07 / $243.94 / $421.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.07 / $198.48 / $278.07