go back

Minnesota 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 / $363.08 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $676.08 / $977.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $676.08 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $2,511.89 / $6,025.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $891.25 / $977.24
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,511.89 / $4,677.35
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,047.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $676.08 / $1,348.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $302.00 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $398.11 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $331.13 / $776.25