go back

New Jersey 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
$159.46 / $159.46 / $159.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.46 / $193.77 / $282.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.80 / $286.80 / $433.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.36 / $209.36 / $515.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.41 / $399.19 / $568.41
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.73 / $433.90 / $433.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.65 / $218.83 / $360.78