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North Carolina rates for HCPCS L7405

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.68 / $656.68 / $1,332.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.70 / $656.68 / $656.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.77 / $1,308.76 / $1,611.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.25 / $661.72 / $661.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.54 / $624.54 / $624.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.91 / $624.54 / $1,017.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.48 / $656.68 / $1,059.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.60 / $645.60 / $645.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.80 / $1,027.80 / $1,580.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.17 / $442.02 / $690.54
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,474.25 / $4,086.48 / $4,086.48
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,418.01 / $6,423.90 / $6,423.90