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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
$245.47 / $245.47 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $218.78 / $363.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $478.63 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $316.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $275.42 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $234.42 / $380.19
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $630.96