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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
$191.76 / $191.76 / $191.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.76 / $219.16 / $221.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.29 / $391.35 / $391.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $515.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.91 / $268.43 / $2,070.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.09 / $261.82 / $452.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.65 / $213.03 / $298.45