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North Dakota rates for HCPCS L7401

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.68 / $304.68 / $304.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$304.68 / $346.90 / $346.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.56 / $462.96 / $474.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $484.80 / $609.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.75 / $304.68 / $1,928.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.84 / $276.89 / $338.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.07 / $276.89 / $333.67