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Louisiana 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
$257.04 / $346.74 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $229.09 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $660.69 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $354.81 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $213.80 / $302.00