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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
$329.01 / $329.01 / $329.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.01 / $374.68 / $374.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.82 / $499.92 / $512.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.63 / $523.80 / $658.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.56 / $329.01 / $2,083.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.16 / $299.02 / $365.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.09 / $316.17 / $474.26