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Texas 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
$196.88 / $196.88 / $212.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.88 / $212.63 / $393.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.76 / $267.76 / $267.76
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.69 / $449.69 / $449.69
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
$751.50 / $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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $337.60 / $449.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.15 / $404.72 / $449.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $318.35 / $449.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $232.40 / $339.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.13 / $245.76 / $300.36
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.80 / $243.00 / $449.69