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New Jersey 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
$239.88 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $323.59 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $436.52
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $707.95 / $977.24
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $660.69 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $346.74 / $537.03