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Nebraska 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
$282.12 / $282.12 / $282.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.12 / $282.12 / $332.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.81 / $427.69 / $432.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $486.63 / $486.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.37 / $515.25 / $750.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.73 / $479.60 / $2,070.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.43 / $261.82 / $367.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$485.20 / $486.63 / $613.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.00 / $575.11 / $1,002.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.43 / $220.70 / $346.24