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Rhode Island rates for HCPCS L7403

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $234.42 / $660.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $870.96 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $245.47 / $457.09
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 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $302.00 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $251.19 / $363.08