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Vermont 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 / $239.88 / $275.42
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
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $426.58 / $537.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $331.13 / $912.01