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Minnesota 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
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $239.88 / $371.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $446.68 / $645.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,659.59 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $588.84 / $660.69
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,659.59 / $3,162.28
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $707.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $446.68 / $912.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $199.53 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $263.03 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $218.78 / $512.86