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New Hampshire rates for HCPCS L5595

Preparatory Hip Disarticulation-Hemipelvectomy Pylon No Cover Sach Foot Thermoplastic Or Equal Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,342.16 / $3,342.16 / $4,010.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,264.83 / $2,593.44 / $3,342.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,935.66 / $5,935.66 / $7,036.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,952.48 / $2,952.48 / $3,084.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $3,578.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $3,578.08
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,805.84 / $4,805.84 / $14,833.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,318.62 / $3,628.23 / $4,805.84
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,445.62 / $4,890.18 / $6,223.87