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Rhode Island rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $354.81 / $1,000.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,288.25 / $1,513.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $346.74 / $691.83
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 / $436.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $457.09 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $380.19 / $549.54