go back

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
$289.42 / $289.42 / $289.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.42 / $330.76 / $333.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.90 / $590.65 / $590.65
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 / $434.07 / $434.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $405.13 / $3,124.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.36 / $395.17 / $682.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.36 / $321.52 / $450.46