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Oklahoma 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
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $229.09 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $363.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $389.05 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $275.42 / $1,380.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $223.87 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $457.09 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $199.53 / $295.12