go back

North Dakota 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
$489.78 / $489.78 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $363.08 / $562.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $741.31 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $977.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $562.34 / $3,090.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $338.84 / $676.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $977.24 / $977.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $407.38 / $724.44