go back

Ohio 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
$217.09 / $217.09 / $589.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.59 / $217.09 / $298.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.23 / $351.23 / $351.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$417.47 / $489.05 / $1,267.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.73 / $247.67 / $584.19
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.90 / $377.90 / $377.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.44 / $444.59 / $600.20
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.55 / $402.30 / $951.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $523.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $369.67
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $286.80 / $286.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.87 / $221.80 / $305.32