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New Hampshire rates for HCPCS L7403

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

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 / $467.74 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $288.40
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 / $269.15 / $295.12
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 / $616.60