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North Carolina rates for HCPCS L7400

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.89 / $276.89 / $561.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.42 / $276.89 / $276.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$298.26 / $357.92 / $679.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.00 / $279.02 / $279.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $536.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.46 / $276.89 / $446.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.22 / $272.22 / $272.22
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.40 / $433.40 / $666.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.59 / $185.59 / $279.29
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$621.58 / $1,722.99 / $1,722.99
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.87 / $2,708.48 / $2,708.48