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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
$232.72 / $232.72 / $232.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.72 / $232.72 / $232.72
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.09 / $255.09 / $298.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $232.40 / $232.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.79 / $283.79 / $866.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.21 / $217.82 / $372.29