go back

Tennessee 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
$286.64 / $292.26 / $292.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.14 / $292.26 / $502.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.93 / $607.12 / $607.12
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 / $434.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.68 / $3,124.60 / $3,124.60
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,378.23 / $3,378.23 / $4,911.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.36 / $336.55 / $460.81