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Hawaii 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
$160.44 / $160.44 / $160.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.84 / $346.84 / $346.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.35 / $318.35 / $480.26
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.60 / $457.17 / $457.17
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.95 / $436.60 / $611.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.26 / $432.23 / $480.26
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.70 / $363.76 / $415.57