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Montana rates for HCPCS L7403

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

Facilitymedian $437 · 10th–90th $295–$6310%20%10th90th$437Professionalmedian $282 · 10th–90th $141–$5130%10%10th90th$282$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $263.03 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $467.74 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $467.74 / $467.74
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $436.52 / $851.14
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $436.52 / $851.14
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $416.87 / $630.96
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $354.81 / $467.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $295.12 / $316.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $199.53 / $302.00