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New Hampshire rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$988.53 / $988.53 / $1,186.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.39 / $767.07 / $988.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,755.62 / $1,755.62 / $2,081.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.70 / $1,450.68 / $1,450.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $963.22 / $963.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $703.15 / $992.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.44 / $1,421.44 / $4,387.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.79 / $1,039.98 / $1,421.44
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.89 / $1,446.38 / $1,840.85