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California rates for HCPCS L7403

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $239.88 / $1,659.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $229.09 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $478.63
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $758.58 / $1,023.29
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $812.83 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $288.40
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $288.40 / $537.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $398.11 / $724.44
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,235.94 / $3,235.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $446.68 / $575.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $426.58
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $346.74 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $263.03 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $239.88 / $436.52