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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
$240.67 / $240.67 / $240.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.67 / $292.47 / $425.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.07 / $434.07 / $654.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.87 / $316.87 / $573.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.30 / $602.53 / $857.95
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.57 / $654.91 / $654.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.30 / $344.49 / $654.91