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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
$263.89 / $364.74 / $364.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.16 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $471.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.91 / $305.64 / $433.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.51 / $412.21 / $433.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $320.21 / $381.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.94 / $423.73 / $635.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.73 / $314.61 / $455.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.19 / $198.13 / $336.25