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New Hampshire rates for HCPCS L6026

Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,025.34 / $3,025.34 / $3,630.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,218.58 / $2,266.67 / $3,025.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,077.68 / $5,077.68 / $6,019.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,246.42 / $3,443.26 / $3,443.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,323.97 / $3,323.97 / $3,323.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,426.50 / $2,426.50 / $3,323.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,111.17 / $4,111.17 / $12,689.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,688.80 / $2,533.19 / $4,111.17
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,803.01 / $4,183.31 / $5,324.21