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Colorado 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
$339.18 / $339.18 / $339.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.18 / $339.18 / $507.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$678.36 / $762.21 / $1,383.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.13 / $403.13 / $435.38
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 / $714.44
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $339.18 / $901.37
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.05 / $193.05 / $193.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.20 / $847.95 / $1,356.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.49 / $299.04 / $460.81