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Virginia 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
$345.40 / $345.40 / $349.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.95 / $345.40 / $360.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.91 / $654.91 / $695.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.13 / $403.13 / $503.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.41 / $398.41 / $447.70
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.44 / $589.42 / $785.90
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $402.78 / $731.73
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.64 / $860.24 / $1,090.88
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.81 / $503.47 / $836.67
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.81 / $503.47 / $836.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.04 / $326.73 / $468.72