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Arkansas rates for HCPCS L7404

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $323.59 / $524.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218,776.16 / $524,807.46 / $954,992.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $588.84 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $316.23 / $436.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $691.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $323.59 / $457.09