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Illinois rates for HCPCS L7405

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $446.68 / $870.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,698.24 / $6,025.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $954.99
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $1,230.27
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $707.95 / $1,288.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $436.52 / $676.08