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New Jersey 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
$160.44 / $160.44 / $160.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.44 / $194.98 / $283.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $436.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $232.40 / $382.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.87 / $401.67 / $571.95
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.37 / $436.60 / $436.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.86 / $220.19 / $363.03