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New Hampshire rates for HCPCS L6584

Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, USMC or equal pylon, no cover, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,604.39 / $1,604.39 / $1,925.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,194.95 / $1,244.96 / $1,604.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,849.36 / $2,849.36 / $3,377.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.84 / $1,500.84 / $1,567.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,960.76 / $1,960.76 / $1,960.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.35 / $1,431.35 / $2,090.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,307.00 / $2,307.00 / $7,120.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.68 / $1,421.51 / $2,270.30
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,134.08 / $2,347.48 / $2,987.71