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North Carolina rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.71 / $334.71 / $679.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.18 / $334.71 / $334.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.54 / $432.65 / $821.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.08 / $337.28 / $337.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $318.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $318.35 / $518.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.69 / $334.71 / $540.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.08 / $329.08 / $329.08
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.90 / $523.90 / $805.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.38 / $224.35 / $351.97
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$751.50 / $2,083.02 / $2,083.02
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,252.01 / $3,274.50 / $3,274.50