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Wisconsin rates for HCPCS L7403

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

Facilitymedian $457 · 10th–90th $407$8320%20%40%10th90th$457Professionalmedian $331 · 10th–90th $195$6760%20%10th90th$331$0.5$2.0$10.0$50.0$200.0$1.0K

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
$223.87 / $223.87 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $223.87 / $371.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $741.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $426.58 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $1,047.13 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $645.65 / $851.14
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $363.08 / $562.34
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $549.54 / $691.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $446.68 / $2,089.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $281.84 / $501.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $512.86 / $891.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $676.08 / $1,258.93
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $912.01 / $2,089.30
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $416.87 / $2,238.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $295.12 / $457.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $223.87 / $371.54