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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
$562.04 / $562.04 / $562.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.74 / $527.85 / $562.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.82 / $671.03 / $934.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.82 / $637.48 / $671.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $2,070.13 / $5,749.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.75 / $824.42 / $987.74
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,229.01 / $1,986.19 / $4,527.26
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.75 / $777.75 / $800.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.84 / $671.03 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.36 / $334.43 / $673.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.36 / $333.10 / $673.82