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Arizona 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
$294.70 / $301.77 / $502.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.94 / $621.15 / $1,123.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.85 / $573.14 / $780.90
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 / $316.87 / $777.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $360.01 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.27 / $299.04 / $460.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.27 / $299.04 / $450.46