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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
$374.24 / $576.87 / $576.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.79 / $986.97 / $1,829.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.72 / $500.26 / $643.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.54 / $624.54 / $624.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.91 / $455.91 / $624.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.49 / $693.49 / $693.49
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.28 / $576.87 / $576.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.33 / $589.27 / $982.69