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New Hampshire rates for HCPCS L7404

Addition To Upper Extremity Prosthesis Above Elbow Disarticulation Acrylic Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.75 / $368.75 / $442.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.14 / $292.47 / $441.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.91 / $654.91 / $776.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.51 / $403.13 / $403.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $434.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $316.87 / $434.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.25 / $530.25 / $1,636.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.82 / $326.73 / $450.46
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.51 / $539.55 / $686.71