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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
$417.62 / $417.62 / $877.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.62 / $428.48 / $436.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.25 / $785.39 / $877.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.64 / $476.72 / $643.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$661.72 / $965.28 / $1,316.30
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.90 / $965.28 / $1,184.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.54 / $624.54 / $877.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.91 / $624.54 / $900.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.73 / $437.78 / $602.66