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New Hampshire rates for HCPCS L7400

Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.34 / $203.34 / $244.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.79 / $161.27 / $243.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.13 / $361.13 / $428.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.93 / $222.31 / $222.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $239.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $239.35
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.39 / $292.39 / $902.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.11 / $180.17 / $248.40
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.48 / $297.52 / $378.67