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North Dakota 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 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $239.88 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $501.19 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $371.54 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $223.87 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $645.65 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $275.42 / $478.63