go back

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
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $218.78 / $331.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $457.09 / $562.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $269.15 / $467.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $562.34 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $288.40 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $316.23 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $223.87 / $302.00