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Illinois 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
$332.12 / $332.12 / $332.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.47 / $332.12 / $550.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$801.36 / $1,355.76 / $5,773.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.98 / $509.98 / $509.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $734.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $777.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.92 / $771.68 / $939.44
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.34 / $872.34 / $872.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.48 / $334.76 / $574.67