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Louisiana 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
$389.05 / $524.81 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $346.74 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,000.00 / $1,380.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
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 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $537.03 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $323.59 / $457.09