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Alaska rates for HCPCS L7403

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material

Facilitymedian $240 · 10th–90th $129–$4470%20%40%10th90th$240Professionalmedian $295 · 10th–90th $214–$5370%10%10th90th$295$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $281.84 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $478.63
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $281.84 / $426.58
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $416.87 / $1,412.54
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $426.58 / $446.68
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $426.58 / $446.68
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $446.68
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $288.40 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $218.78 / $954.99