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New Jersey 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
$132.71 / $132.71 / $132.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.71 / $161.27 / $234.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.35 / $239.35 / $361.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.73 / $174.73 / $429.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.92 / $332.24 / $473.08
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.67 / $361.13 / $361.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.83 / $194.05 / $361.13