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New Hampshire rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,290.77 / $1,290.77 / $1,548.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$770.79 / $1,001.60 / $1,290.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,292.37 / $2,292.37 / $2,717.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,054.47 / $1,054.47 / $1,101.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $1,232.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.89 / $899.89 / $1,269.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,856.04 / $1,856.04 / $5,728.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.43 / $1,143.64 / $1,926.85
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,716.92 / $1,888.61 / $2,403.69