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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
$660.69 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $501.19 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,318.26 / $1,778.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $676.08 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $1,023.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $446.68 / $575.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $741.31 / $1,288.25
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $588.84 / $707.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $436.52 / $616.60
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,073.80
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $6,456.54 / $6,456.54