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Missouri 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
$204.17 / $302.00 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $234.42 / $645.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $1,584.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $245.47 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $457.09
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $354.81 / $1,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $223.87 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $354.81 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $223.87 / $316.23