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Idaho 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
$398.32 / $550.53 / $550.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.76 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $316.87 / $462.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $461.32 / $654.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.42 / $622.16 / $654.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $483.33 / $575.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.47 / $639.57 / $959.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.44 / $474.85 / $687.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.49 / $299.04 / $474.28