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Pennsylvania rates for HCPCS L7403

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

Facilitymedian $537 · 10th–90th $195–$7410%20%10th90th$537Professionalmedian $219 · 10th–90th $191–$3890%20%40%10th90th$219$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$194.98 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $218.78 / $371.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $288.40
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $575.44 / $831.76
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $309.03 / $446.68
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $194.98
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $218.78 / $331.13
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $588.84 / $851.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $416.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $537.03 / $616.60
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $239.88 / $446.68