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Tennessee 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
$191.08 / $194.83 / $194.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $194.83 / $334.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.94 / $404.74 / $404.74
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 / $318.35
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$607.11 / $2,083.02 / $2,083.02
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,252.01 / $2,252.01 / $3,274.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.57 / $219.67 / $307.20