go back

South Carolina 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
$199.53 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $218.78 / $331.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $446.68 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $512.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $295.12
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $323.59 / $707.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $302.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $295.12 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $223.87 / $302.00