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New Hampshire rates for HCPCS L7403

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

Facilitymedian $447 · 10th–90th $245–$5250%20%40%10th90th$447Professionalmedian $295 · 10th–90th $200–$3980%20%10th90th$295$200.0$500.0$1.0K$2.0K

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
$245.47 / $245.47 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $245.47 / $363.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $467.74 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $288.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $707.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $269.15 / $295.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $295.12 / $380.19
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$416.87 / $416.87 / $616.60