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Tennessee 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 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $213.80 / $380.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $363.08
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,311.31 / $3,311.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $263.03 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $218.78 / $302.00