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Minnesota 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
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $467.74 / $741.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $870.96 / $1,288.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $870.96 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,311.31 / $7,943.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,148.15 / $1,288.25
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,235.94 / $6,165.95
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $870.96 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $389.05 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $512.86 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $436.52 / $1,023.29