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New Hampshire rates for HCPCS L5150

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,427.65 / $2,427.65 / $2,913.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,882.25 / $2,037.28 / $2,528.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,311.49 / $4,311.49 / $5,110.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,574.31 / $2,574.31 / $2,689.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,249.00 / $3,249.00 / $3,249.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.77 / $2,371.77 / $3,249.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,490.81 / $3,490.81 / $10,774.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.97 / $2,150.94 / $3,167.50
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,229.15 / $3,552.07 / $4,520.81