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Connecticut 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
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $218.78 / $389.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $446.68 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $269.15 / $275.42
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 / $208.93
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $309.03 / $436.52
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $263.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $218.78 / $302.00