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Wyoming 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
$339.18 / $339.18 / $593.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$662.46 / $662.46 / $662.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.46 / $662.46 / $662.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $734.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $316.87 / $434.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.27 / $398.72 / $460.81