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Tennessee 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
$176.96 / $180.43 / $180.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.64 / $180.43 / $309.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.13 / $374.83 / $374.83
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 / $267.94
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.25 / $1,928.91 / $1,928.91
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,085.52 / $2,085.52 / $3,032.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.52 / $207.77 / $284.45