go back

New Hampshire rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.97 / $1,887.97 / $2,265.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,281.42 / $1,465.01 / $1,887.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,353.01 / $3,353.01 / $3,974.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.36 / $1,696.36 / $1,780.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.07 / $1,743.07 / $1,743.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.44 / $1,272.44 / $1,743.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,714.77 / $2,714.77 / $8,379.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.18 / $1,672.78 / $2,096.37
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.29 / $2,762.42 / $3,515.81