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New Hampshire rates for HCPCS L5540

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, laminated socket, molded to model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.17 / $1,395.17 / $1,674.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.31 / $1,082.63 / $1,668.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,477.82 / $2,477.82 / $2,937.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,317.91 / $1,317.91 / $1,386.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,599.98 / $1,599.98 / $1,599.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.99 / $1,167.99 / $1,705.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,006.19 / $2,006.19 / $6,192.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.11 / $1,236.16 / $1,632.56
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,855.80 / $2,041.38 / $2,598.12