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Indiana rates for HCPCS L7402

Addition To Upper Extremity Prosthesis Shoulder Disarticulation/Interscapular Thoracic Ultralight Material (Titanium Carbon Fiber Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.89 / $212.89 / $447.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.89 / $218.42 / $222.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.38 / $400.35 / $447.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.10 / $243.00 / $328.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.28 / $492.05 / $670.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.22 / $492.05 / $603.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $447.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $318.35 / $458.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $223.16 / $316.14