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South Dakota rates for HCPCS L7403

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

Facilitymedian $372 · 10th–90th $331$7410%20%40%10th90th$372Professionalmedian $372 · 10th–90th $195$6310%10%20%10th90th$372$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$371.54
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$363.08
Typical High
$436.52
Cigna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$501.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$645.65
Medica
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$457.09
Typical High
$1,202.26
Medica
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$302.00
Typical High
$2,238.72
Midlands
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$489.78
Typical High
$489.78
Midlands
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
Midlands
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$812.83
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$446.68
Typical High
$588.84
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$302.00
Typical High
$524.81
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$436.52