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Virginia rates for HCPCS L7403

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

Facilitymedian $447 · 10th–90th $229–$5500%20%40%10th90th$447Professionalmedian $240 · 10th–90th $195–$4270%20%10th90th$240$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $229.09 / $229.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $229.09 / $346.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $467.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $562.34
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $208.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $446.68 / $616.60
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $295.12 / $295.12
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $323.59 / $524.81
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $288.40
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $380.19 / $1,288.25
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $380.19 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $295.12 / $537.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $218.78 / $346.74