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Idaho rates for HCPCS L7403

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $263.03 / $371.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $416.87 / $630.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $288.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $416.87 / $457.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $416.87 / $446.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $371.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $426.58 / $426.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $323.59 / $489.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $446.68 / $457.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $295.12 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $199.53 / $302.00