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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
$372.39 / $372.39 / $372.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.25 / $349.73 / $372.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.85 / $444.59 / $619.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.67 / $422.36 / $444.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $1,371.81 / $3,810.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.25 / $546.16 / $654.37
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.43 / $1,316.19 / $3,000.08
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.25 / $515.25 / $530.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.75 / $444.59 / $2,070.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.09 / $221.58 / $446.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.13 / $239.47 / $780.92