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Arkansas 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
Facility
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $213.80 / $346.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218,776.16 / $524,807.46 / $954,992.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $234.42 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $457.09 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $213.80 / $309.03