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Maryland rates for HCPCS L7403

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $229.09 / $371.54
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $302.00
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 / $288.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $446.68 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $295.12 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $223.87 / $346.74
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $371.54