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Wyoming 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
$209.39 / $209.39 / $366.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.96 / $408.96 / $408.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.96 / $408.96 / $408.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.94 / $267.94 / $453.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.60 / $195.60 / $267.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.84 / $246.14 / $284.45