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Wisconsin 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
$225.66 / $225.66 / $225.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.34 / $225.66 / $378.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.32 / $492.05 / $814.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.58 / $416.01 / $550.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.80 / $957.26 / $957.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $987.80 / $1,867.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $658.65 / $846.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $338.49 / $514.41
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.12 / $436.60 / $536.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.78 / $447.32 / $2,083.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.26 / $298.88 / $487.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $338.49 / $514.41
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.12 / $436.60 / $536.78
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.32 / $688.41 / $1,196.41
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $873.68 / $2,083.02
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $318.35 / $2,252.01
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.32 / $447.32 / $447.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.32 / $447.32 / $447.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.13 / $265.81 / $447.32