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New Hampshire rates for HCPCS L6697

Addition To Upper Extremity Prosthesis Below Elbow/Above Elbow Custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.69 / $872.69 / $1,047.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.19 / $692.14 / $1,043.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,549.90 / $1,549.90 / $1,837.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.47 / $954.08 / $954.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.22 / $1,111.22 / $1,111.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.19 / $811.19 / $1,111.22
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.88 / $1,254.88 / $3,873.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.48 / $773.22 / $1,090.83
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.82 / $1,276.90 / $1,625.15