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New Hampshire rates for HCPCS L5617

Addition to lower extremity, quick change self-aligning unit, above knee (AK) or below knee (BK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.93 / $389.93 / $467.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.39 / $302.58 / $466.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.54 / $692.54 / $820.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.51 / $405.82 / $405.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.96 / $436.96 / $436.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $318.98 / $450.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.72 / $560.72 / $1,730.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.33 / $345.50 / $506.58
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.67 / $570.54 / $726.15