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Kentucky 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
$194.94 / $214.02 / $222.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.83 / $217.14 / $238.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$279.94 / $449.71 / $472.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.34 / $240.00 / $243.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.28 / $626.25 / $720.39
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.22 / $559.15 / $742.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $527.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $318.35 / $2,145.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.57 / $224.35 / $332.26