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Michigan 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
$383.21 / $383.21 / $383.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.35 / $383.21 / $383.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,015.64 / $2,023.56 / $3,685.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.48 / $671.03 / $905.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.70 / $436.17 / $438.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.82 / $536.82 / $536.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.14 / $434.07 / $777.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.21 / $484.90 / $484.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.21 / $484.90 / $754.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.07 / $496.56 / $571.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.20 / $320.79 / $480.25