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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
$331.13 / $331.13 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $257.04 / $331.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $446.68 / $891.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $346.74 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $512.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $223.87 / $295.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $371.54 / $660.69
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $302.00 / $363.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $316.23
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,311.31 / $3,311.31