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New York 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
$158.49 / $354.81 / $501.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $229.09 / $380.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $446.68 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $758.58
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $363.08 / $363.08
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $707.95 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $446.68
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $741.31 / $1,698.24
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $467.74 / $851.14
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $309.03 / $323.59
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $281.84 / $309.03
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $457.09 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $234.42 / $363.08
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $263.03 / $323.59
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $281.84 / $309.03