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Nebraska 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
$426.58 / $426.58 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $426.58 / $2,818.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $645.65 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $776.25 / $1,148.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $724.44 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $398.11 / $660.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,659.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,148.15 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $446.68 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $331.13 / $501.19