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Massachusetts 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
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $218.78 / $398.11
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $426.58 / $2,089.30
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $331.13 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $389.05 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $316.23
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $575.44
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $426.58 / $2,089.30
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $338.84 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $302.00 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $302.00 / $380.19