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Missouri 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
$203.38 / $300.83 / $310.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.38 / $233.04 / $423.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.15 / $467.41 / $2,054.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.21 / $243.00 / $360.27
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 / $339.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.38 / $372.86 / $2,083.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.13 / $237.94 / $359.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.13 / $222.08 / $329.21