go back

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
$374.93 / $374.93 / $374.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.00 / $374.93 / $374.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.32 / $770.72 / $856.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.91 / $654.91 / $674.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.91 / $654.91 / $654.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $539.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $526.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.36 / $336.52 / $450.71