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Alaska rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.49 / $573.49 / $573.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $462.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $193.05 / $193.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.16 / $622.16 / $982.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $193.05 / $434.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $462.74 / $767.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.73 / $326.73 / $626.23