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Nebraska 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
$562.34 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $562.34 / $3,715.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $851.14 / $851.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,023.29 / $1,513.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $954.99 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $512.86 / $851.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $2,187.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $2,187.76 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $588.84 / $912.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $436.52 / $660.69