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Missouri 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
$305.04 / $451.21 / $465.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.04 / $349.53 / $635.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.68 / $701.06 / $3,082.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.84 / $403.13 / $540.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $316.87 / $462.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.04 / $559.25 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.20 / $356.91 / $539.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.20 / $334.76 / $472.82