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Iowa 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
$493.54 / $562.04 / $562.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.02 / $360.01 / $567.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $734.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.07 / $777.75 / $972.19
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.48 / $695.28 / $851.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.79 / $867.98 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.20 / $417.73 / $912.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.30 / $734.45 / $910.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.52 / $857.94 / $1,403.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.20 / $344.21 / $785.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.33 / $654.33 / $654.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.91 / $654.33 / $654.33