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New Hampshire rates for HCPCS L7402

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultra-light material (titanium, carbon fiber or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.83 / $245.83 / $295.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $194.98 / $294.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.60 / $436.60 / $517.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.00 / $243.00 / $255.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.35 / $318.35 / $318.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.40 / $232.40 / $318.35
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.50 / $353.50 / $1,091.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.21 / $217.82 / $353.50
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.00 / $359.70 / $457.80