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Iowa 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
$323.59 / $346.74 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $229.09 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $512.86 / $645.65
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $501.19 / $602.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $562.34 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $295.12 / $741.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $501.19 / $602.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $741.31 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $331.13 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $229.09 / $407.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $436.52 / $436.52