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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
$382.32 / $382.32 / $382.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $318.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $318.35 / $339.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $128.69 / $128.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.77 / $414.77 / $654.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $128.69 / $318.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $339.37 / $511.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.02 / $217.82 / $417.48