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North Dakota 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
$326.99 / $326.99 / $326.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.99 / $372.39 / $372.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.22 / $496.85 / $509.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.25 / $520.40 / $654.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.75 / $326.99 / $2,070.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.05 / $297.20 / $363.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.13 / $314.24 / $471.36