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North Carolina rates for HCPCS L7403

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.70 / $332.70 / $675.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.97 / $332.70 / $332.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.37 / $430.04 / $816.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.20 / $335.25 / $335.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $644.05
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.91 / $332.70 / $536.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.10 / $327.10 / $327.10
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.70 / $520.70 / $800.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.34 / $223.01 / $349.85
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.91 / $2,070.19 / $2,070.19
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.21 / $3,254.25 / $3,254.25