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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$173.78 / $218.78 / $616.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $812.83 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $213.80 / $426.58
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 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $281.84 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $234.42 / $338.84