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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
$190.55 / $239.88 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $389.05 / $549.54
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $446.68 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $269.15 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $331.13 / $478.63