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Ohio rates for HCPCS L7403

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

Facilitymedian $479 · 10th–90th $263$7940%20%40%10th90th$479Professionalmedian $229 · 10th–90th $191$3890%20%40%10th90th$229$0.5$2.0$10.0$50.0$200.0$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
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $218.78 / $363.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $478.63 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $275.42 / $588.84
Aultcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $380.19
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $380.19 / $537.03
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $398.11 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $288.40
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $288.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $380.19 / $549.54
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $512.86 / $933.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $363.08 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $218.78 / $302.00