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Connecticut 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
$316.23 / $316.23 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $323.59 / $588.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $660.69 / $812.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $407.38 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $426.58 / $426.58
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $467.74 / $660.69
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $323.59 / $457.09