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Missouri 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
$202.11 / $298.95 / $308.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.11 / $231.59 / $421.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.39 / $464.51 / $2,042.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.82 / $267.12 / $358.07
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 / $209.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.11 / $370.54 / $2,070.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.11 / $236.47 / $357.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.11 / $220.70 / $327.17