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Michigan 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
$501.14 / $501.14 / $501.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.62 / $501.14 / $501.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,328.19 / $2,646.28 / $4,819.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.65 / $877.53 / $1,184.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$556.74 / $570.39 / $573.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.02 / $702.02 / $702.02
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 / $624.54 / $1,017.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.14 / $634.13 / $634.13
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.14 / $634.13 / $986.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.96 / $649.37 / $746.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.92 / $419.51 / $620.19