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Illinois 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
$218.78 / $218.78 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $229.09 / $436.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $870.96 / $3,090.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $489.78
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $549.54 / $660.69
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $354.81 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $223.87 / $346.74