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Kansas 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
$502.05 / $502.05 / $502.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.05 / $349.53 / $559.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.12 / $403.28 / $428.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.51 / $431.51 / $431.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $972.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $538.11 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.36 / $356.91 / $853.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.07 / $333.10 / $460.81