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Georgia 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
$187.34 / $187.34 / $530.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.34 / $240.00 / $299.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.71 / $629.59 / $1,650.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.00 / $373.92 / $717.93
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.11 / $382.25 / $831.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.25 / $382.25 / $382.25
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.78 / $449.71 / $896.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.00 / $224.35 / $447.32