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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
$241.55 / $256.42 / $364.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.68 / $256.42 / $371.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.01 / $664.57 / $934.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.29 / $317.33 / $317.33
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $515.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.09 / $222.97 / $315.88