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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
$556.87 / $556.87 / $556.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$556.87 / $556.87 / $656.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.48 / $844.23 / $852.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.54 / $960.55 / $960.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$624.54 / $960.55 / $1,481.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.64 / $946.68 / $4,086.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.46 / $516.82 / $726.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.74 / $960.55 / $1,210.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$857.00 / $1,135.20 / $1,978.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.83 / $435.65 / $602.66