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Florida 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
$288.01 / $309.74 / $354.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.01 / $345.40 / $502.09
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 / $434.07
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.99 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.18 / $486.98 / $674.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.66 / $539.66 / $539.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.69 / $336.55 / $450.75
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.13 / $403.13 / $674.58