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Arizona rates for HCPCS L7405

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $446.68 / $1,698.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $478.63 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $794.33 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $630.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $562.34 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $389.05 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $602.56 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $389.05 / $588.84