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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$190.55 / $234.42 / $676.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $229.09 / $467.74
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $309.03 / $549.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $251.19 / $363.08