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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
$316.23 / $316.23 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $331.13 / $501.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $691.83 / $851.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $407.38 / $691.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,023.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $478.63 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $331.13 / $457.09