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Alaska rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $263.03 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $338.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $380.19 / $426.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $446.68 / $1,445.44
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $426.58 / $446.68
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $426.58 / $436.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $446.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $316.23 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $218.78 / $954.99