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Washington, DC 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
$234.42 / $234.42 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $213.80 / $295.12
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $309.03
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 / $338.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $630.96 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $218.78 / $331.13