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Arizona 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
$196.47 / $201.18 / $334.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.62 / $414.08 / $748.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.56 / $382.08 / $520.58
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 / $232.40 / $518.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $240.00 / $2,083.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.18 / $199.36 / $307.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.32 / $199.36 / $300.30