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Idaho rates for HCPCS L7403

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

Facilitymedian $417 · 10th–90th $275–$5250%20%10th90th$417Professionalmedian $309 · 10th–90th $195–$4900%10%20%10th90th$309$50.0$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
$194.98 / $263.03 / $371.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $416.87 / $707.95
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $288.40 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $288.40
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $416.87 / $467.74
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $398.11 / $446.68
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $371.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $426.58 / $426.58
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $467.74
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $446.68 / $457.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $295.12 / $302.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $199.53 / $302.00