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North Carolina rates for HCPCS L7404

Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.09 / $502.09 / $1,018.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.77 / $502.09 / $502.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.54 / $1,000.64 / $1,232.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.64 / $505.94 / $505.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $434.07 / $777.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.05 / $502.09 / $810.32
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.64 / $493.64 / $493.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.90 / $785.90 / $1,208.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.57 / $336.55 / $506.45
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.33 / $3,124.60 / $3,124.60
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,378.23 / $4,911.89 / $4,911.89