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Kentucky 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
$323.59 / $323.59 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $323.59 / $562.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $691.83 / $724.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $363.08 / $407.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $912.01 / $1,174.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $851.14 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $691.83 / $3,235.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $446.68 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $338.84 / $457.09