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Idaho 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
$265.54 / $367.02 / $367.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.83 / $318.35 / $318.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $232.40 / $339.37
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $307.54 / $436.60
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.94 / $414.77 / $436.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $322.21 / $383.73
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$382.31 / $426.37 / $639.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.62 / $316.55 / $458.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.32 / $199.36 / $338.33