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New Hampshire rates for HCPCS L6628

Upper extremity addition, quick disconnect hook adapter, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.44 / $384.44 / $461.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.74 / $298.31 / $459.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.75 / $682.75 / $809.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.65 / $349.65 / $366.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.49 / $444.49 / $444.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.48 / $324.48 / $457.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$552.79 / $552.79 / $1,706.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.00 / $108.00 / $108.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.08 / $340.61 / $432.10
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.36 / $562.50 / $715.90