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Texas rates for HCPCS L7401

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.32 / $182.32 / $196.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.32 / $196.90 / $364.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.18 / $198.18 / $247.95
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.42 / $416.42 / $416.42
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
$695.81 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.17 / $312.62 / $416.42
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.52 / $374.78 / $416.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.17 / $278.23 / $416.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $195.60 / $285.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.84 / $227.57 / $280.08
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.91 / $248.87 / $416.42