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Kansas 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
$332.65 / $332.65 / $332.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.91 / $231.59 / $370.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.58 / $529.79 / $561.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.85 / $525.85 / $525.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $644.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.91 / $356.52 / $2,070.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.09 / $236.47 / $565.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.13 / $220.70 / $305.32