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Indiana 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
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $218.78 / $331.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $457.09 / $575.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $245.47 / $457.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $562.34 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $316.23 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $316.23 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $223.87 / $309.03