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Maryland 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
Professional
Modifier
Low / Median / High Price
$187.34 / $214.09 / $349.08
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.09 / $255.09 / $298.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $318.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $232.40 / $318.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.62 / $436.60 / $628.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.66 / $219.58 / $341.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.80 / $241.80 / $305.62