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Oklahoma 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
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $229.09 / $371.54
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 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $281.84 / $1,380.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $223.87 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $457.09 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $204.17 / $302.00