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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
$244.32 / $244.32 / $293.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.59 / $193.77 / $292.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.90 / $433.90 / $514.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.44 / $267.12 / $267.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $286.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $286.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.31 / $351.31 / $1,084.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.31 / $216.47 / $351.31
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.98 / $357.48 / $454.97