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Oklahoma 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
$288.40 / $288.40 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $346.74 / $562.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $588.84 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $724.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $416.87 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $338.84 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $691.83 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $302.00 / $446.68