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Tennessee 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
$189.93 / $193.66 / $193.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.59 / $193.66 / $332.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.33 / $402.30 / $402.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $286.80
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$603.45 / $2,070.19 / $2,070.19
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.21 / $2,238.21 / $3,254.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.66 / $218.35 / $305.32