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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
$562.34 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $346.74 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $407.38 / $426.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $776.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $467.74 / $1,479.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $331.13 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $537.03 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $331.13 / $457.09