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Virginia 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
$230.27 / $230.27 / $232.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.63 / $230.27 / $240.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.60 / $436.60 / $463.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.00 / $243.00 / $310.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.09 / $255.09 / $298.45
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.62 / $392.94 / $523.91
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $268.51 / $487.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.08 / $573.49 / $727.25
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.20 / $335.64 / $557.77
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.20 / $335.64 / $557.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.86 / $217.82 / $328.10