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Virginia 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
$451.74 / $451.74 / $456.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.16 / $451.74 / $470.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.52 / $856.52 / $909.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.72 / $476.72 / $609.92
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.08 / $521.08 / $585.52
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.55 / $770.87 / $1,027.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.48 / $526.78 / $957.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.60 / $1,125.05 / $1,426.69
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$469.27 / $658.47 / $1,094.26
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.27 / $658.47 / $1,094.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.10 / $427.31 / $620.28