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Maine 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
$389.05 / $446.68 / $1,318.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,023.29 / $1,148.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $870.96
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $891.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $537.03 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $512.86 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $602.56 / $831.76