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New Hampshire rates for HCPCS L7405

Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $436.52 / $724.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $933.25 / $1,071.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $630.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $537.03 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $457.09 / $741.31
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,230.27