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Below Elbow or Wrist Disarticulation, Acrylic Material

Pennsylvania rates for HCPCS L7403

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

Rates data updated October 2026.

How much does Below Elbow or Wrist Disarticulation, Acrylic Material cost?

$288

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $288 for this service. The price depends on where it is billed: about $275 from a physician practice, and about $316 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 10 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$275$209 to $417
FacilityA hospital or hospital-owned outpatient department$316$288 to $1,413

How much rates vary

Facilitymedian $316 · 10th to 90th $288 to $2,399Professionalmedian $275 · 10th to 90th $195 to $437
$200$1K$5K$20Kfacility $316professional $275

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$204.17
Aetna
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$194.98
Typical High
$213.80
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$346.74
Median
$436.52
Typical High
$436.52
Cigna
Setting
Facility
Modifier
None
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Professional
Modifier
None
Typical Low
$208.93
Median
$208.93
Typical High
$2,187.76
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$407.38
Median
$645.65
Typical High
$741.31
Geisinger
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Geisinger
Setting
Professional
Modifier
None
Typical Low
$263.03
Median
$288.40
Typical High
$446.68
Highmark BCBS
Setting
Professional
Modifier
None
Typical Low
$302.00
Median
$302.00
Typical High
$354.81
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$204.17
Typical High
$213.80
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$616.60
Typical High
$660.69
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$309.03
Median
$1,412.54
Typical High
$2,398.83
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$309.03
Typical High
$416.87
United
Setting
Facility
Modifier
None
Typical Low
$537.03
Median
$537.03
Typical High
$645.65
United
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$218.78
Typical High
$338.84

Where Pennsylvania sits

The same service costs 2.4 times more in Kansas than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 22nd of 51

$288

KS $501DE $209

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.