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Indiana 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
$211.59 / $211.59 / $444.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.59 / $217.09 / $221.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.23 / $397.91 / $444.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.73 / $267.12 / $360.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.25 / $489.05 / $666.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.90 / $489.05 / $600.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $444.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $456.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.09 / $221.80 / $314.22