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New Hampshire rates for HCPCS L6638

Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.11 / $1,659.11 / $1,990.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.43 / $1,315.86 / $1,984.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,946.56 / $2,946.56 / $3,492.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,647.60 / $1,647.60 / $1,721.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,952.91 / $1,952.91 / $1,952.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,425.62 / $1,425.62 / $2,081.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,385.69 / $2,385.69 / $7,363.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$980.00 / $1,470.01 / $2,073.29
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,206.88 / $2,427.57 / $3,089.63