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Washington rates for HCPCS L7403

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

Facilitymedian $437 · 10th–90th $282$9770%20%10th90th$437Professionalmedian $309 · 10th–90th $195$6310%20%10th90th$309$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$489.78
Typical High
$660.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$239.88
Typical High
$389.05
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$426.58
Typical High
$426.58
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$489.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$288.40
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$588.84
Typical High
$1,230.27
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$512.86
Typical High
$912.01
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$331.13
Typical High
$363.08
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$426.58
Typical High
$436.52
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$436.52
Typical High
$446.68
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$630.96
Typical High
$870.96
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$363.08
Typical High
$426.58
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$489.78
United
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$645.65
Typical High
$645.65
United
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$263.03
Typical High
$380.19
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$309.03
Typical High
$660.69