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Indiana 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
$416.87 / $416.87 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $436.52 / $660.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $891.25 / $1,122.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $478.63 / $851.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,096.48 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $616.60 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $436.52 / $602.56