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Indiana 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
$319.35 / $319.35 / $671.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.35 / $327.64 / $333.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.11 / $600.57 / $671.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.18 / $403.13 / $544.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.94 / $738.13 / $1,006.55
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.38 / $738.13 / $905.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $671.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $688.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.36 / $334.76 / $474.25