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Connecticut 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
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $218.78 / $389.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $446.68 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $257.04 / $263.03
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 / $234.42
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $316.23 / $436.52
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $165.96 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $218.78 / $309.03