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Hawaii 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
$240.67 / $240.67 / $240.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.27 / $520.27 / $520.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.07 / $434.07 / $720.41
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.91 / $685.78 / $685.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.95 / $654.91 / $916.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.22 / $520.27 / $720.41
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.55 / $545.64 / $623.36